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D.14
To: Board of Supervisors
From: William Walker, M.D., Health Services Director
Date: July  21, 2015
The Seal of Contra Costa County, CA
Contra
Costa
County
Subject: Recommendations for Award of the Emergency Ambulance RFP (Request for Proposal) for Exclusive Operating Area (EOA) I, II and V

APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE

Action of Board On:   07/21/2015
APPROVED AS RECOMMENDED OTHER
Clerks Notes:

VOTE OF SUPERVISORS

Contact: Patricia Frost, 925-313-9554
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown.
ATTESTED:     July  21, 2015
David Twa,
 
BY: , Deputy

 

RECOMMENDATION(S):

1. ACCEPT the recommendation from the Health Services Director regarding the award of a contract to the Contra Costa County Fire Protection District (CCCFPD), on behalf of the "Alliance". The Alliance refers to the contractor and subcontractor arrangement established between CCCFPD and American Medical Response (AMR), respectively, associated with the proposal to provide emergency ambulance services.  
  


RECOMMENDATION(S): (CONT'D)
2. AUTHORIZE the Health Services Director, or designee, to negotiate a contract with CCCFPD as sole bidder for emergency ambulance services and subject to sub-contracting with American Medical Response, in accordance rates and terms specified in Plan A as described in the response to the Emergency Ambulance Request for Proposal for the period of January 1, 2016 through January 1, 2021 with the option to renew the contract for an additional 5 years subject to a Board finding that the Alliance is in compliance with contract requirements and standards prior to January 1, 2020.  
  
3. DIRECT the Health Services Director, or designee, staff to return to the Board with a negotiated contract for final approval no later than September 2015.

FISCAL IMPACT:

The current emergency ambulance contract requires no subsidy and under Plan A it is anticipated that a subsidy will not be required during the first five years of the new contract. The financial impact of the proposed Alliance bid for emergency ambulance services is contained in the attached report titled "Independent Financial Review of Elements Related to the County's Ambulance RFP", authored by Citygate Associates, LLC and facilitated by the County Administrator's Office.

BACKGROUND:

Request for Proposals Process  
  
On February 27, 2015, the Contra Costa Emergency Medical Services Agency, the Local EMS Agency (LEMSA), posted the Board-approved 2015 Contra Costa County Request for Proposal for Emergency Ambulance Service. On March 19, 2015 the LEMSA and RFP consultant Fitch and Associates conducted a mandatory proposer’s conference with three prospective bidders in attendance:

  • The Alliance: The contractor and subcontractor arrangement established between CCCFPD and AMR, and approved by the CCCFPD Governing Board on May 12, 2015.
  • Falck Northern California
  • Medic Ambulance
The deadline for the receipt of emergency ambulance service proposals was May 21, 2015 at 4pm. A single emergency ambulance proposal was received from the Alliance. A public proposal opening was conducted at 4pm on May 21, 2015 at the LEMSA offices located at 1340 Arnold Drive in compliance with the Brown Act. The Alliance proposal was posted on the LEMSA website that same day.  
  
A proposal review process followed and was conducted in accordance with requirements approved by the California EMS Authority. The proposal review process was managed by the LEMSA and its RFP Consultant (Fitch and Associates). A multi-disciplinary proposal was reviewed and scored by a panel of four out-of-county independent EMS professionals and one local representative appointed by the Board. In addition two board appointed independent observers from the county were invited to observe the two-day panel review proceedings on June 4-5, 2015. The proposal review panel concluded with a presentation by the Alliance on June 5, 2015. The findings of the proposal review panel were submitted to the Health Services Director shortly following the panel review meeting. Subsequently, the Health Services Director requested from the Alliance on June 22, 2015. This information was received prior to the request deadline of 5pm on July 6, 2015.   
  
Independent Financial Review Process  
  
The Board of Supervisors directed County Administrator to conduct an independent financial review of bids submitted in response to the LEMSA RFP for emergency ambulance services. The County Administrator's Office retained Citygate Associates LLC to provide the independent financial review and render an opinion on the relative strengths and weaknesses of each proposal. Upon reviewing the bid submitted by the Alliance as described above, the County Administrator's Office determined that additional financial information was necessary to properly conduct the financial review and render and opinion. On June 8, 2015, the County Administrator formally requested the additional information from CCCFPD as lead agency for the Alliance and received a response on June 15, 2015. Alliance representatives met with Citygate Associates LLC for follow up discussion regarding the financial aspects of the proposal on June 19, 2015 and have remained in contact during the report development phase.  
  
Alliance Proposal Structure  
  
The Alliance model, with a first responder Fire District as contractor and the private ambulance provider as subcontractor is an entirely new approach for providing emergency ambulance services not seen previously in California. The Alliance model has the potential to provide a Countywide EMS System benefits and challenges in the following areas:
  • Collaboration between first responders and ambulance personnel may be significantly improved
  • Efficiencies associated with co-located dispatch and resulting enhancements in coordinated deployment and operations of emergency medical services for the communities served could be realized.
  • A complex contracting structure adds to the number of governing boards involved in approval processes which may reduce the private ambulance provider’s (now a subcontractor under the Alliance model) level of responsiveness and flexibility in the provision of services.
  • Confusion over LEMSA roles and responsibilities may increase associated with LEMSA statutory requirements under Title 22, Division 9: Prehospital Emergency Medical Services and California Emergency Services Law Health and Safety Code Division 2.5 responsible for medical control, patient safety and prehospital care oversight as part of an coordinated EMS System plan for countywide emergency services.
It would be the intent of the LEMSA to fulfill its roles and responsibilities as the contract administrator and Local EMS regulator in a similar fashion as it has conducted business with previous contractors. The Health Services Director and LEMSA staff request that the Board consider all information when determining the recommendation to award and provide direction to staff on the procurement for county emergency ambulance services for EOA I, II, and V.  
  
Links to Key Documents  
  
1. Contra Costa EMS RFP webpage: http://cchealth.org/ems/rfp.php  
2. Request for Proposals: Exclusive Operator for Emergency Ambulance Service Contra Costa County (February 27, 2015) http://cchealth.org/ems/pdf/RFP2015-contracosta-ambulance.pdf  
3. Alliance Proposal and Supporting documents:

CONSEQUENCE OF NEGATIVE ACTION:

The emergency ambulance contract would not be awarded at this time. The current contract with American Medical Response (AMR) for emergency ambulance service ends on December 31, 2015. In order to continue emergency ambulance services to Exclusive Operating Areas I, II and V (which covers approximately 90% of the county emergency ambulance services) past December 31, 2015; EMS staff would recommend that the Board direct EMS staff to renew the AMR contract for an additional 18 months and to go back out to bid for emergency ambulance services.

CHILDREN'S IMPACT STATEMENT:

Not applicable.

CLERK'S ADDENDUM

Speakers:  Peter Clark, Happy Valley Improvement Association; Bill Granados, CCC Fire Protection District Advisory Commission; Dan Colbath, Firefighters' Local 1230.

Supervisor Mitchoff expressed her desire to see staff's analysis, recommendations and thoughts on the two components (operating and savings) of a reserve fund. 

The Board ADOPTED all recommendations as presented, to include the recommendations of the consultant Citygate Associates LLC.

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