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DATE: |
May 2, 2023 and May 23, 2023 |
02 |
SUBJECT
Title
ADMINISTRATIVE ITEM:
SECOND CONSIDERATION AND ADOPTION OF ORDINANCE:
NOTICE OF PUBLIC HEARING: AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES (5/02/23 - FIRST READING; 5/23/23 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) (DISTRICTS: ALL)
Body
OVERVIEW
On May 2, 2023 (22), the Board of Supervisors took action to further consider and adopt the Ordinance on May 23, 2023.
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 and waive Board Policy B-29, Fees, Grants, and Revenue Contracts - Department responsibility for full cost recovery, related to fees charged for services by the County of San Diego (County) Emergency Medical Services Office (EMS). The Board last approved revisions to EMS’s fees on April 5, 2022 (15).
By regularly reviewing costs and fees, departments can recuperate costs in a systematic manner, ensure all fees are fair and equitable, and enable stakeholders to plan for fee increases. In accordance with Board Policy B-29, County EMS recently reviewed eight fees and associated costs, and proposes adjustments to three of those fees during Fiscal Year 2023-24, including three fee increases. Five fees remain unchanged. 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 steps. The ordinance will be introduced on May 2, 2023, and, if approved, it will be scheduled for adoption on May 23, 2023. If the proposed ordinance is altered on May 23, 2023, then on that date a subsequent meeting date will be selected for the ordinance’s adoption. In addition, today’s recommendations request the waiving of Board Policy B-29, due to recent labor negotiations and the timing of the current fee package as Year 3 out of three years of a phased fee increase.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
Consider and adopt (unless ordinance is modified on second reading):
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY CODE OF ADMINISTRATIVE ORDINANCES, RELATING TO SAN DIEGO COUNTY EMERGENCY MEDICAL SERVICES FEES.
EQUITY IMPACT STATEMENT
Services and oversight provided by the San Diego County Emergency Medical Services Office (EMS) is supported through a fee for individuals and agencies for the credentialing of prehospital personnel (Emergency Medical Technicians, Paramedics and Mobile Intensive Care Nurses), ambulance permitting, and inspections for private agencies, approval for continuing education providers, and the hospital specialty care designations for base station hospitals and trauma centers. The EMS office provides this detailed level of oversight ensuring the San Diego community receives medical care by appropriately licensed and verified personnel, properly permitted transport vehicles, and appropriately designated hospital facilities.
SUSTAINABILITY IMPACT STATEMENT
Today’s actions are supportive of the County of San Diego’s (County) Sustainability goals to provide just and equitable access to County services by ensuring all EMS responders are appropriately credentialed in a comprehensive and timely manner. 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 three revised EMS fees will be effective July 1, 2023. Funds will be included in the Fiscal Year 2023-25 CAO Recommended Operational Plan for County Fire. The funding source is fees paid by customers. Fees do not cover all the operating costs. These costs will be supported by County Fire’s existing General Purpose Revenue. 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 April 27, 2023, to the Emergency Medical Care Committee.
BACKGROUND
The County of San Diego (County) Emergency Medical Services Office (EMS) 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 do not address cost increases based on negotiated labor agreements, due to the timing of the fee package and the labor negotiations. Increased costs in Fiscal Year 2023-24 due to approved labor negotiations will be reflected in future cost recovery packages.
On May 4, 2021 (18), the Board approved a three-year phased approach to achieve cost recovery through fees charged to prehospital personnel as described in Attachment D. In order to continue the phased fee increases to address full cost recovery for purposes of EMS personnel fees, County EMS performed an analysis of all services provided to customers to examine the tasks and functions performed, including the direct and indirect costs. Criteria were established to determine a fair and equitable fee for direct services provided.
County EMS is proposing updates to three of the eight fees it reviewed. The proposed fee package reflects known costs as accurately as possible. The County Auditor and Controller reviewed and approved the supporting documentation and methodology of EMS fee updates. In EMS advisory committee meetings, County EMS will communicate 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 D for additional details):
|
Action |
Number of Fees |
Description |
|
Increases |
3 |
• EMT/Advanced EMT Initial/Renewal from current $126 to $146 • Paramedic Accreditation Initial from current $126 to $146 • Mobile Intensive Care Nurse Authorization Initial from current $126 to $146 |
|
No Change |
5 |
• Ambulance Provider Permit remains $3,549 • Continuing Education Provider remains $1,335 • Base Station Hospital Designation remains $24,888 • Annual Vehicle Inspection remains $325 • Trauma Center Hospital Designation remains $47,503 |
|
Total Fees |
8 |
|
Today’s action proposes to update three fees, change ordinance language per Attachment B, and amend the County Administrative Code Article XX Section 370 Emergency Medical Services Fees. If approved, fee updates will be effective July 1, 2023.
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 (County) 2023-2028 Strategic Plan. Periodically reviewing the San Diego County Emergency Medical Services Office fees ensures that the County has optimized its service delivery system to ensure efficiency, integration and innovation while maintaining fiscal stability.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Interim Chief Administrative Officer
ATTACHMENT(S)
Attachment A - Summary Comparison of Current and Proposed Fees
Attachment B - An Ordinance Amending Article XX of the San Diego County Code of Administrative Ordinances, Relating to San Diego County Emergency Medical Services Fees (Clean Copy)
Attachment C - An Ordinance Amending Article XX of the San Diego County Code of Administrative Ordinances, Relating to San Diego County Emergency Medical Services Fees (Informational Copy)
Attachment D - Summary of Cost Recovery Proposal Actions
Attachment E - Approved 3-Year Phase-in of EMS Personnel Fees for FY 21‐22 through FY 23‐24
Attachment F - Summary of Proposed Ordinance