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DATE: |
April 30, 2024 and May 21, 2024 |
21 |
SUBJECT
TitleNOTICE OF PUBLIC HEARING:
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES (4/30/24 - FIRST READING; 5/21/24 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) (DISTRICTS: ALL)
Body
OVERVIEW
Today’s action requests that the San Diego County Board of Supervisors (Board) approve amendments to Article XX of the San Diego County Administrative Code for fees charged by the County of San Diego (County) Emergency Medical Services (EMS) Office, a division of San Diego County Fire. The Board last approved revisions to three of the eight EMS’s fees on May 2, 2023 (22).
The EMS Office is the Board of Supervisors designated Local EMS Agency (LEMSA), which coordinates and regulates the EMS delivery system in our region. This includes: the permitting and inspecting of ambulances to ensure the safety of the public and employees; assuring that all EMS personnel are vetted and approved to work in our system; providing epidemiologic research, trend identification and clinical effectiveness metrics; and linking prehospital data to the State of California and specialty care registries, such as trauma, stroke and cardiac care. These activities ensure that all residents and visitors receive appropriate and timely emergency medical care in the field and by designated specialty care centers.
By regularly reviewing costs and fees, departments can recuperate costs in a systematic manner, ensure fees are fair and equitable, and enable stakeholders to plan for future fees and fee increases. In accordance with Board Policy B-29, County EMS recently reviewed eight existing fees and associated costs and after doing so, proposes adjustments to all eight during Fiscal Year 2024-25 with the addition of one new fee, for a total of nine fees. Attachment A is a summary comparison of current and proposed fees. The Auditor and Controller has reviewed and approved the supporting documentation and methodology for the proposed fee adjustments.
Today’s request includes two options for fee increases, each with two steps. The ordinance will be introduced on April 30, 2024, and, if approved, it will be scheduled for adoption on May 21, 2024. If the proposed ordinance is altered on May 21, 2024, then on that date a subsequent meeting date will be selected for the ordinance’s adoption. The two options consist of Option A, achieving full cost recovery with the fees in one year through a one-time fee increase and Option B, a phased-in approach to increase the fees with a goal to achieve full cost recovery within three years. If Option B is selected, a request to waive Board Policy B-29 for full cost recovery is also requested.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
Approve one of the following options below for a fee increase:
OPTION A: Achieve full cost recovery in Fiscal Year 2024-25
On April 30, 2024:
1. Approve the introduction of the “Option A” Ordinance (first reading):
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES.
If, on April 30, 2024, the Board takes actions recommended in Item 1 above in Option A, then on May 21, 2024:
1. Consider and adopt (unless ordinance is modified on second reading):
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES.
OPTION B: Achieve full cost recovery within three years with a phased increase beginning in Fiscal Year 2024-25
On April 30, 2024:
1. Waive Board Policy B-29, Fees, Grants, and Revenue Contracts - Department Responsibility for Cost Recovery which requires full cost recovery for services.
2. Approve the introduction of the “Option B” Ordinance (first reading):
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES.
If, on April 30, 2024, the Board takes actions recommended in Items 1-2 above in Option B, then on May 21, 2024:
1. Consider and adopt (unless ordinance is modified on second reading):
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES
EQUITY IMPACT STATEMENT
The fees before the Board support services and oversight provided by San Diego County (County) Emergency Medical Services (EMS) Office to individuals and agencies for the credentialing of prehospital personnel (Emergency Medical Technicians (EMT), Paramedics and Mobile Intensive Care Nurses (MICNs)), ground and air ambulance permitting and inspections for private agencies, approval for continuing education providers, and base station and trauma center hospital specialty care designations. The County EMS Office provides this detailed level of oversight ensuring the San Diego community receives equitable medical care by appropriately credentialed, trained, and verified personnel; permitting and inspecting privately operated transport vehicles; and designating specialized hospital facilities as required by State statute.
SUSTAINABILITY IMPACT STATEMENT
Today’s actions are supportive of the County’s Sustainability goals to provide just and equitable access to County services by ensuring all Emergency Medical Service responders are appropriately credentialed in a comprehensive and timely manner, all private ground and air ambulances are permitted and inspected, continuing education providers have accurate and current lesson plans and course records, and hospitals have the appropriate specialty care designations. In terms of economic sustainability, amending these fees will continue County Emergency Medical Services Office work to ensure full cost recovery for the work performed within three years, depending on the option selected by the Board of Supervisors. This allows for general purpose revenue to be available for other programs, ensuring the long-term solvency and fiscal stability of these and other County services. The proposed actions further ensure just and equitable access to goods and services through reasonable fee amounts that are levied only on those services necessary to ensure such cost recovery.
FISCAL IMPACT
There is no fiscal impact in the current fiscal year. If approved, the eight revised and one new EMS fee(s) will be effective July 1, 2024. Funds are included in the Fiscal Year 2024-25 CAO Recommended Operational Plan for County Fire for Option A. If full cost recovery of the fees (Option A) is chosen, costs and revenue of $2.3M will be generated in Fiscal Year 2024-25. If fee increases are phased in over three years to achieve full cost recovery (Option B), revenue of $1.6M will be generated in Fiscal Year 2024-25 which will not cover all the operating costs for these services. The unrecovered costs of $700,000 will be supported with existing General Purpose Revenue in San Diego County Fire. The funding source is fees paid by customers. There is no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
This item was presented as an informational item on March 28, 2024, to the Emergency Medical Care Committee.
BACKGROUND
The County of San Diego (County) Emergency Medical Services (EMS) Office is committed to maintaining the highest quality work product and customer service while continuously evaluating its services for efficiency, accuracy, and equity. The continued increases in the cost of doing business requires the evaluation of fees to align with current costs. Today’s proposed fee changes reflect standard assumptions made by the County and the Auditor and Controller has reviewed and approved the supporting documentation and methodology for the proposed fee adjustments.
The EMS Office is the Board of Supervisors designated Local EMS Agency (LEMSA), which coordinates and regulates the EMS delivery system in our region. This includes establishing clinical standards; countywide EMS leadership and innovation; ambulance service permitting and vehicle inspections to ensure the safety of the public and employees; assuring that all EMS personnel are vetted and approved to work in our system; providing epidemiologic research, trend identification and clinical effectiveness metrics; and linking prehospital data to the State of California and specialty care registries, such as trauma, stroke, and cardiac care. The LEMSA’s data driven and expert clinical guidance ensures a high quality, coordinated and readily accessible EMS system and supports quality assurance practices with a patient-centered focus. These activities ensure that all residents and visitors receive appropriate and timely emergency medical care in the field and by designated specialty care centers.
In an effort to comply with County Board Policy B-29 and achieve full cost recovery through fees charged to prehospital personnel, private ambulances (including air ambulance), continuing education providers, and for the hospital specialty care designations for base stations and trauma centers, the County EMS Office performed an analysis of all services provided to customers to examine the tasks and functions performed, including the direct and indirect costs.
EMS fees were increased in 2021 based on time and cost data from FY 19-20, with the EMS personnel fees (EMTs, Paramedics, and MICNs) increasing over a three-year period. For other non-personnel related EMS fees, a time and cost study was last completed using FY 20-21 data.
The fees proposed in Option A achieve full cost recovery with a fee increase in Fiscal Year 24-25. The fees proposed in Option B phases the increases over three years with the goal to achieve full cost recovery by Fiscal Year 26-27. The County EMS Office will continue to analyze the fees to include increases in County costs and return to the Board annually with updated fees, in an effort to achieve full cost recovery. The County EMS Office is proposing updates to eight fees and the addition of one new fee, which are currently the only EMS Office fees. The proposed fee package reflects known costs as accurately as possible in compliance with Board Policy B-29 in Option A and a waiver to Board Policy B-29 in Option B. These fees were last updated May 2, 2023. Should the Board choose to not increase the fees, the EMS Office programs supported by fees will remain partly supported with general purpose dollars.
In addition to the nine fees included in today’s Board action, the County EMS Office will also review other services that are provided to determine if it is suitable and reasonable to establish new fees. By reviewing other services and related costs, the County EMS Office may return next year with additional new fees, which could further reduce the dependence on general purpose dollars. Currently, the County EMS Office has 8 fees that total $1.1M. If the Board approves one of today’s recommendations, County EMS will have either 9 fees that total $2.3M (Option A) or 9 fees that total $1.6M (Option B) in Fiscal Year 2024-25.
In EMS advisory committee meetings, the County EMS Office has communicated with stakeholders the County’s obligation for full cost recovery and the department’s commitment to revisit the fees annually. The overall analysis results in the following fee recommendations (see Attachments A and F for additional details):
OPTION A: Provides $2.3M in revenue in Fiscal Year 2024-25, which is over $1.1M more than current collections.
|
Action |
Number of Fees |
Description |
|
Increases |
8 |
• EMT/Advanced EMT Initial/Renewal from current $146 to $233 • Paramedic Accreditation Initial from current $146 to $233 • Mobile Intensive Care Nurse Authorization Initial from current $146 to $233 • Ambulance Provider Permit from current $3,549 to $14,748 • Annual Vehicle Inspection from current $325 to $373 • Continuing Education Provider from current $1,335 to $5,197 • Base Station Hospital Designation from current $24,888 to $74,753 • Trauma Center Hospital Designation from current $47,503 to $68,235 |
|
New |
1 |
• Air Ambulance Fee $5,239 |
|
Total Fees |
9 |
|
OPTION B: Provides $1.6M in revenue in Fiscal Year 2024-25, which is over $400k more than current collections, but $.700M less than full cost recovery.
|
Action |
Number of Fees |
Description |
|
Increases |
8 |
• EMT/Advanced EMT Initial/Renewal from current $146 to $183 • Paramedic Accreditation Initial from current $146 to $183 • Mobile Intensive Care Nurse Authorization Initial from current $146 to $183 • Ambulance Provider Permit from current $3,549 to $6,400 • Annual Vehicle Inspection from current $325 to $373 • Continuing Education Provider from current $1,335 to $2,350 • Base Station Hospital Designation from current $24,888 to $39,800 • Trauma Center Hospital Designation from current $47,503 to $57,000 |
|
New |
1 |
• Air Ambulance Fee $5,239 |
|
Total Fees |
9 |
|
Today’s action proposes to update eight fees, establish one new fee, change ordinance language with options noted in Attachments B through Attachment E, and amend the County Administrative Code Article XX Section 370 Emergency Medical Services Fees. If approved, fee updates will be effective July 1, 2024, based on the approved Option. If Option B is selected, the recommendation includes a waiver of Board Policy B-29 since full cost recovery will not be achieved in year 1. The difference between Options A and B is approximately $700,000.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the Empower and Equity Initiatives in the County of San Diego’s 2024-2029 Strategic Plan. Periodically reviewing the San Diego County Emergency Medical Services (EMS) Office fees ensures that the County has optimized its service delivery system to ensure efficiency, integration, and innovation while maintaining fiscal stability.
Respectfully submitted,
sarah E. agHassi
Interim Chief Administrative Officer
ATTACHMENT(S)
Attachment A: Summary Comparison of Current and Proposed Fees
Attachment B: Option A- An Ordinance Amending Article XX of the San Diego County Administrative Ordinance Code, Relating to San Diego County Emergency Medical Services Fees (Clean Copy)
Attachment C: Option A- An Ordinance Amending Article XX of the San Diego County Administrative Ordinance Code, Relating to San Diego County Emergency Medical Services Fees (Informational Copy)
Attachment D: Option B- An Ordinance Amending Article XX of the San Diego County Administrative Ordinance Code, Relating to San Diego County Emergency Medical Services Fees (Clean Copy)
Attachment E: Option B- An Ordinance Amending Article XX of the San Diego County Administrative Ordinance Code, Relating to San Diego County Emergency Medical Services Fees (Informational Copy)
Attachment F: Summary of Cost Recovery Proposal Actions
Attachment G: Summary of Proposed Ordinance