Pursuant to Division 2.5 of the California Health & Safety Code (“Health & Safety Code”), the County has designated the Yolo County Health Department (now a part of the Health and Human Services Agency) to be the Local Emergency Medical Services Agency (“LEMSA”) for the purpose of the administration of emergency medical services (“EMS”) within the County.
Division 2.5 of the Health and Safety Code confers specific authorities and responsibilities upon a LEMSA, including but not limited to developing a local plan through which it may establish one or more exclusive operating areas (“EOAs”) and, through a competitive process approved by the State Emergency Medical Services Authority (“State EMS Authority”), contracting with one or more ambulance providers for the provision of ambulance services in the designated EOA or EOAs pursuant to the local plan.
Yolo County EMS Agency (“YEMSA”) has developed a local plan, approved by the State EMS Authority, for the establishment of a single EOA covering the entire County, and the selection of a single ambulance provider to provide specified ambulance services, including Emergency Ambulance Services with basic life support (BLS), advanced life support (ALS), and critical care transport (CCT) for all areas within the EOA.
On February 25, 2014, the original contract with American Medical Response was approved by the Board awarding complete exclusivity of the emergency ambulance services, ALS, and CCT for a five (5) year period, with an optional (5) years extension. On February 26, 2019 an amendment authorizing a five (5) years extension was also approved by the Board.
American Medical Response has met or exceeded all contractual requirements since awarding the original contract in 2014.
Yolo County EMS Agency went out for bid in 2020 for an EMS Consultant to do a system assessment and draft the next completive bid and contract agreement for Yolo County EMS Agency. The contract has completed the install survey and a system assessment report will follow. The goal is to go out to bid in 2023 to award the next exclusive operating area 9-1-1 Ambulance Service in 2024.
American Medical Response is entitled to request Consumer Price Index (CPI) increases to their base rate for ambulance fees annually, which they have requested only four times since the original agreement (2016, 2018, 2020, and February 2021). They are requesting a 20% increase in their base rate of service to the commercial payers, effective upon Board approval, due to substantial reductions in revenue caused by factors that are beyond their control.
Contributing factors to the requested rate increase include:
- The affordable care act (ACA). Government payers like Medicare and Medi-Cal remain unresponsive to county-approved rate increases, continue to reimburse medical providers at rates far below the cost of providing care, and represent almost 75% of our ambulance patients within Yolo County.
- Ambulance transports covered by commercial insurance, the only payer paying rates that cover care costs, have decreased. The fee-for-service model in healthcare has been increasingly challenging for all medical providers, and Yolo County ambulance transportation is no exception.
- Since the original contract's execution, Agreement No 14-25, AMR has only requested four of the possible eight CPI increases. They are entitled to yearly increases. Based on the EMS Administrator’s assessment of the system, the past Operational Manager and Regional Director failed to ask for CPI, contributing to the current request.
- Demand for 911/CCT services has slowed significantly. The further decline in 2020 was due to increased safety measures taken during the COVID pandemic to identify patients whose condition does not require transport by 9-1-1 emergency ambulance.
Below is a table showing what the base rate would be with the CPI increase each year, the bolded years are the only years CPI was requested.
| CPI% |
|
2.40% |
2.50% |
3.0% |
3.4% |
3.6% |
3.5% |
2.9% |
1.6% |
Rate if
CPI was requested each year |
2013 |
2014 |
2015 |
2016 |
2017 |
2018 |
2019 |
2020 |
2021 |
| advanced life support (ALS) |
1,975.00 |
2,022.40 |
2,072.96 |
2,135.15 |
2,207.74 |
2,287.22 |
2,367.28 |
2,435.93 |
2,474.90 |
| basic life support (BLS) |
854.17 |
874.67 |
896.54 |
923.43 |
954.83 |
989.20 |
1,023.83 |
1,053.52 |
1,070.37 |
| critical care transport (CCT) |
4,429.18 |
4,535.48 |
4,648.87 |
4,788.33 |
4,951.14 |
5,129.38 |
5,308.91 |
5,462.86 |
5,550.27 |
Table showing years where the rate increase was requested, the current rate, and 20% requested increase:
| |
2013 |
2016 |
2018 |
2020 |
Current Rate
Effective 2/1/2021 |
Requested Rate |
| ALS |
1,975.00 |
2,073.75 |
2,148.41 |
2,202.12 |
2,246.15 |
2,695.39 |
| BLS |
854.17 |
896.88 |
929.17 |
952.40 |
971.45 |
1,165.74 |
| CCT |
4,429.18 |
4,650.64 |
4,817.87 |
4,938.32 |
5,037.09 |
6,044.51 |
Table showing 2013 vs 2021 Base Rates Growth Rate by County using Compound Annual Growth Rate (CAGRG), showing the percentage of growth with the requested 20% increase:
| |
ALS |
|
BLS |
|
CCT |
| County |
2013 |
2021 |
8-yr
CAGR % |
|
2013 |
2021 |
8-yr
CAGR % |
|
2013 |
2021 |
8-yr
CAGR % |
| Placer |
1,647.11 |
2,042.67 |
2.7% |
|
917.05 |
1,176.99 |
3.2% |
|
4,429.18 |
4,985.09 |
1.5% |
| Sacramento |
1,555.79 |
3,176.90 |
9.3% |
|
738.48 |
1,403.17 |
8.4% |
|
4,429.18 |
9,204.47 |
9.6% |
| San Francisco |
1,816.86 |
3,320.23 |
7.8% |
|
1,388.86 |
2,327.08 |
6.7% |
|
3,690.98 |
9,204.47 |
12.1% |
| San Joaquin |
2,033.15 |
3,315.75 |
6.3% |
|
1,733.89 |
2,946.47 |
6.9% |
|
3,690.98 |
9,120.31 |
12.0% |
| San Mateo |
2,101.21 |
2,827.76 |
3.8% |
|
1,379.00 |
2,327.08 |
6.8% |
|
n/a |
n/a |
n/a |
| Santa Barbara |
2,068.86 |
3,071.34 |
5.1% |
|
1,344.70 |
1,996.27 |
5.1% |
|
3,820.16 |
5,592.92 |
4.9% |
| Shasta |
2,084.22 |
2,586.01 |
2.7% |
|
1,389.35 |
1,723.85 |
2.7% |
|
4,429.18 |
5,495.57 |
2.7% |
| Sonoma |
1,600.59 |
2,264.18 |
4.4% |
|
1,239.62 |
1,854.74 |
5.2% |
|
4,429.18 |
5,883.37 |
3.6% |
| Stanislaus |
2,322.18 |
3,185.61 |
4.0% |
|
1,022.85 |
1,403.17 |
4.0% |
|
4,429.18 |
9,204.47 |
9.6% |
| Yolo |
1,975.00 |
2,246.15 |
1.6% |
|
854.17 |
971.45 |
1.6% |
|
4,429.18 |
5,037.09 |
1.6% |
| Yolo - PROPOSED |
|
2,695.39 |
4.0% |
|
|
1,165.74 |
4.0% |
|
|
6,044.51 |
4.0% |
Staff assessment of the cost of business, government payer (Medicare and Medi-Cal) reimbursement rates, and a comparison of base rate charges in nine other neighboring counties has determined that the request for a 20% increase in base rate is warranted. Staff recommends that the Board approve American Medical Response’s request and the associated amendment to agreement No. 19-32. |