The URL can be used to link to this page

Home My WebLink About06-City Clerk CITQOF SAN BERNARDIIO - REQUEQr FOR COUNCIL AcCbN From: Lee Gagnon Business License City Clerk June 24, 19B7 REC'D.-ADMJ~ecRfF"set public hearing date and supervisQ~, 1 ., I Ill" Og.dopt resolution to increase IJU. nl\. I.. I ...1:J medical transportation rat . Dept: Date: Synopsis of Previous Council action: February lB, 19B5 - Council adopted current rates Recommended motion: That a public hearing be scheduled for the meeting of August l7, 19B7 at 9:00 A.M. to consider adopting the resolution to increase ambulance rates and that the City Attorney be instructed to prepare the neces- sary resolution for adoption. That the City Clerk be authorized to publish notice of public hearing in "block ad format" in the San Bernardino Sun newspaper. ~~~ Slgnat e ~ ./ Contact penon: Lee Gaqnon Phone: 5036 SUPPDrtlng data Ittlched: Yes Ward: N/A FUNDING REQUIREMENTS: Amount: N/A Sourcl: (ACCT. NO.) N/A (ACCT. DESCRIPTION) N/A Flnenca: Council Notal: t,. 'Ill."'''' Agenda Item No. CIT~OF SAN BERNARDlrQ - REQUE~ FOR COUNCIL AC~N STAFF REPORT At their meeting of June 16, 1987, the Bureau of Franchises received the attached proposal from Courtesy Services of San Bernardino for an increase in rates for ambulance services. The Bureau of Franchises considered the proposal and then unanimously recommended to the Mayor and Common Council that the fol- lowing rate structures be adopted: (1) Response to a routine nonemergency call (2) Response to a nonroutine emergency call (3) Additional Charges: (a) Each mile or fraction of a mile (b) Waiting time after first fifteen minute period for each sub- sequent fifteen min- ute period or frac- tion thereof there- after (c) Night service sur- charge, seven P.M. to seven A.M. (d) Each additional pati- ent, fifty percent over charge for one patient (e) Carrier shall be permitted in its dis- cretion to fix the rates for special services not spec- ified herein (4) Response to a call for ambulance not used 15-0264 PRESENT RATE BUREAU OF FRANCHISES RECOMMENDED RATE COURTESY PROPOSED RATE $120.00 $143.88 $143.88 174.50 209.23 209.23 6.00 7.19 7.19 11. 00 13.18 13.18 35.00 41. 97 41. 97 15.00 15.00 143.88 .. , o DIN 0 C I T Y oq SAN B/::;.NAR INTEROFFICE MEMORANDUM 8707-20l ,) TO: Raymond D, Schweitzer, City Administrator ~~ FROM: Lee Gagnon, Business License Supervisor SUBJECT: Ambulance Rate Comparison Survey DATE: July 1, 1987 (7122) COPIES: ------------------------------------------------------------- A proposed ambulance rate increase by Courtesy Services of San Bernardino will be on the Council Agenda for July 20, 1987, At the request of Councilwoman Norine Miller, I conduct- ed an ambulance rate comparison survey by contacting a number of surrounding cities, I have attached the results of that survey for your review, I have also attached the current ambulance rates charged by the County of San Bernardino. 7" .' , ( J/ (~~~f' ./ LEE GAGNON Business License Supervisor -- L >< '" i< ::> OJ z o OJ .... '" '" 0. ~ U '" ~ '" u Z '" ,., ::> '" ~ ...., I 3 . 3 ~ ! . . B . ~ ~ = I ~ >. ;! u. ~ o o . . . .. =g, "c g~ a~ . ~ ... &.2 E ~~ ~g 1 .0 .. .. " 1 ., ~ ~i ~ ~~ i~ 13 r ,. .. ~~ ~'" . . f2 ~f :~ " H in . .; . . ~ ~.~ . .- < . . . , e . g~ 2~ :! '" ,. c. i! < . ! : I g . < . I < . I " ~ ;; ": ~= - :~ " ., ~ :~ ~ 110 " ::s ~,; . -~ ",,,, . . . j .. : g'" ..~'.~ ~!:::: .. . .. ...... ..."... ...0..... .....,"', . . . . - . :! l! :] :. ~ . . . . . . . " . . < " '" .... !.:" t.. .......0 . 0_ ........11 II. -. ::;!ii J;8J~ ........!" ...... :>- a",,,.. :; ~ a , i " . c . . . . ~ ~ , . . ~-: .. .,. -~ ~:-: e:. E :.; !I"U .. -;=" .. ,....,0 .. zu.. i " ,; . . ! ~ :; :; . . . 'i! l. I ~! :a ... 'II"''':.. 1 _110: tiid o1::~1 ," 1- o ~! 1= -, ~l ~. ; ;E il :J ~~ " : . 3'; ."'U ll:l;:h. . . . o. "<=..0" ':"',,"$ '1~:. .......... ~~~~,~ ~e~..t ~ l;;: I ! . , ~ J ! o . . j ! o . J . . " . . " ~ =1 .. " ;8 .1 !: ~; .. U ,) ~i i"-' ~1 1'.-1-,',. ,'~',: l'< . ,~ !,.:;j . . . " j ~ - . 1 ~ ~ .: i. ! ., .., , " .~~~ '0 i . :l j j ,. ~ c ! ~ ~ I i = ~ i .i : j u ~ 1 i ~ ... ~ i ' : 0 . 8 ".:. .~ ~ ; " ij ~ c ! t ;, \:~l .l)(' " , .-::' " I, ~~_'~~~'~' . 5 . IEPAR~ENT OF PUULlC i-;::,;'~ o ~~'v' . " % ......~ '?-' ~ *- "':lJ; :&- ~ ~... /~II'I"\\~ COUNTY OF SAN ..:)ARDlNO , --'.... .....",.....".....---.... , ..... ... .. ... ' . '\. ---- i1 ....1lIt. VIew A_ . .. ---..no. CA 12415.0010 · 1714' 317..210 GEOflGE II. JlEmIlSEN. M.D.. ...,... lIlNctor of I'\IlIlIc -.II J....e 2, 1987 Terry L. Russ, Treasurer Ambulance Association of San Bernardino County P.O. Box 934 San Bernardino, CA 92401 Dear Mr. Russ: I have reviewed your application for ambulance service rate adjustment dated May 26, 1987. After doing the cllq)utations specified in the fornula approved by a Resolution of the Board of Supervisors on April 23, 1984, a revenue change of less than 10 percent wuld result, actually a ,86S change in revenue , The new average revenue for full-pay response wuld allow an increase of $7.12. Computatibhs following the formula, yield the following results: Base Rate Mileage I Emergency Night Oxygen Tille Rate ALS Base E1CG All inclusive ALS Service $143.88 7,19 65,35 41,97 17.99 13,18 218,83 29,97 324.83 , The new rates shall become effective J\IIle 19, 1987. I wuld call your attention to the amulance ordinance, Section 31.0819(g)(3), that requires perlIIittees, within 10 days of the effective date of the new rate, to publish these rates in a newspaper of general circulation'in their service area once a week for Q<<l weeks, · ~ 'mJ;~# GE GE . PETTERSEN, M.D. Di tor of Public Health GRP: al cc: Ambulance Providers City Managers EXHIBIT B c - ......... o ~) C I T Y 0 F SAN B ERN A R DIN 0 INTEROFFICE MEMORANDUM 8707-203 TO: Raymond D. Schweitzer, City Administrator FROM: Lee Gagnon, Business License Supervisor SUBJECT: Ambulance Rate Comparison Survey Addendum DATE: July 8, 1987 COPIES: (7129) A of San 1987. proposed ambulance rate increase by Courtesy Services Bernardino will be on the Council Agenda for July 20, On ambulance c'ities. immediate July l, I forwarded to you a report concerning rates currently charged in a number of surrounding I have since contacted two additional cities in the area and have listed their rates below. Upland Nonemergency Base Rate Paramedic Base Emergency Mileage Waiting time per l5 min. Night Charges Advance Life Support Fontana Base Rate Mileage Waiting time per l5 min. Nights and Weekends Emergency Urgent response Oxygen E.K.G. Paramedic Service ;C~ ~ ---- LEE G~r-. ./ 95.00 l40.60 213 . 84 63,86 7.03 per mile l2,88 41. 01 3l7.52 108.86 6.78 per mile 22.22 44,43 61.l0 27.77 33.33 66.65 c ,~ \oj o ~ Courtesy Services of San Bernardino based their rate increase proposal on increased costs in several major areas including bad debts, insurance, equipment replacement, attendants wages and administration. The last rate increase in ambulance rates was granted on February 18, 1985. Increasing the rates as recommended by the Bureau of Franchises would bring City rates in line with the County of San Bernardino ambulance service rates. Courtesy Services of San Bernardino operates under a franchise agreement with the City of San Bernardino. A copy of the rate increase proposal by Courtesy Services of San Bernardino together with a copy of the current rates now charged by the County of San Bernardino have been attached as exhibits A & B respectively. Mr. Steve Rice, President of Courtesy Services of San Bernardino will be present at the hearing to respond to any questions. c -.... ,,) ~ COURTESY SERVICES OF SAN BERNARD I NO. I NC. AMBULANCE RATE INCREASE REOUEST Courtesy Services 01 San Bernardino. Inc. requests the resolution 01 rates for ambulance service be amended as lollows: A. Ambulance Rates Basic Llle Support response to a routine non-emergency $143.88 2. Unscheduled emergency cal I. additional $ 65.35 3. Additional Charges: a. Each ml Ie or I r a c tl on 01 a ml Ie $ 7 . 19 b. Waiting time a It e r I tr S t f 1ft e e n m In ute period: for each subsequent I I I tee n ml nu t e period. or f r a (: t Ion thereof the rea I t e r $ 13. 18 c Night surcharge. 7:00 p.m. to 7 : 00 a. m. Mo n day t h r 0 ugh F rid a y . or weekend service $ 41.97 d. Each additional patient. lolty percent over charge for one patient e. Carrier shall be permitted In Its discretion to f IX the rates lor other special services not specified herein. f. Response to a call lor ambulance not used. 1143.88 EXHIBIT A c ~. ,,) ~) NARRATIVE Presently Courtesy Services. IS In a loss p050ltlon due to Incre~5lng service and technological aemands coupled with e~c;alatlng co':d~ and fruzen or reduced revenue sources from government heal th aS51stante programs. The requested Incredse repre:)ents an 18% In,rea5e In regulatad rates. rate adjustment. T hi!) I S I e S 5 t h a n 9% per ye .:l r ~ I nee 0 u r I a s t C, t Y 5 e r v Ice d ema n d s h a vel n C I e a sed due t 0 a h I g her c a I I v 0 I um e. an ex pan dIn g c ommu nit y and I n ere a sed Ime demands to complete call s Since our last rate .ncrease request In 1985 call volume Increased from It. 709 ann u a I t r an s po r t s to 12. 978 I n t he c, I Y (15. 185 to 1 7 . 6 1 1 total serv.ce area). The population centers have spread throughout the service area whiCh Increase emergency transport times. State and local emergency medIcal serv.ces agencies have Implemented new regulatIons and medical protocols which have extended the tIme necessary to work up and Ireat patients and complete cal Is. To meet the sed ema n d 5 and k e e p 0 u r res p 0 n 5 e t I me 5 wit t') I n rea son a b I e I I m ItS I t is necessery to increase staff Ing and move or add substations. Although the increased demands have ,ncreased our sale. substantIally. the actual revenue generated by those sales has not kept up w.th cost. due to contractual d,sellowances taken by the var .ou. governmental assistance programs. -2- EXHIBIT A c --. J ,) Requ I red and demanded technological advances are IncreasIng co~:" ParamedlClne has become the accepte~ and expected level of carl~ n the community. In order to proper Iy serve InterfaCI I I ty r d n ~ t e r and provide support to city paramedics It IS necessary for u.:. to Increase our commitment to the paramedic program and add nur~lng personnel to our staff. Specialization and diverSity In mecJlcal car e . .e.. deSignated trauma. burn. cardiac and phYSical therapy centers, and the dramatic change in heal th care economics are Increasing the number of phYSICian ordered paramedic Interfacl I, ty t ran S po r t s . In addl tion to the Increased paramedic demands. Courte~y needs to offer crt tical care transport service WI th advanced cardiac life support nurses who can provide medical care beyond the scope of paramedic practice. We have been providing paramedic service for over 10 years. AI thou';!l the program costs US an addl tlonal 185.000 per year to provide. we have not been charging for those services In the CI ty. Paramedic charges are now recognIzed and paid by Medicare and private InSurance plans II IS our intent to Implement paramedic charges under the special services language of the rate resolution In the city. In 0 r de' to maXimize third party revenue on new sales we plan to Index to the paramedic rates set by the County Health OffIcer. We plan to Implemen the crl tical care transport service once the program and charges are approved by the Health Officer. -3- EXHIBIT A c ~ ~) :) Ma/or cost ,ncreases ara gOing to occur ,n equ'pmeut replacement lebor Insurance and bad debt expense (cau5ed by (ontra~tual dl!)sllowances from government PdY program5) We have 8 need to replace 'IX low top amtJU'8n('.e~ wIth larger. mOle- s tat a 0 f t h a a r e Q lJ I pm e n t t 0 a f; ( ,') mm u ~ A 1 f:' 'h t:' 9 row I n 9 d em and 5 0 f 1 h c serVice. Additional paramedic equipment IS needed Con~tantly cheng.ng treatment protocols require new supplies to be added to the ,nventory evary year Labor costs WI I I Increase In aI' lob cla~5tf Icatlons Tor erna 1 n competItive in the EMT labor market and meet the ,ncreased demands for advanced services. personnel need to be added and wage~ ,ncreased. Dispatch IS now enle~ \ng dn era of I ts own w~ are a,1dlnq additional personnel. Increasing WR1es and formalIZing r a ! n I n 9 programs. Office and accounts receivable staff have mOle than doubled ,n the past twelve months. Insurance expense WI I I continue to esr " Our Insurance \:osts have Increased $39.550 which IS up 71 7% and we antICIpate an 80% Increase this year expense We expect a very moderate Increase In general I a b l I \ t Y Ambulance Insurance (vehicle perso~al Injury and proper ty damage. and comprehensive as wel I as medical malpractice) W' I I continue to dramaticallY Increase Wor kmen' 5 compensa t Ion I nsur aoce. wh I eh 15, at 17. 6% par h u n d red dol I a r s 0 f pay r 0 I I. w I I I 1 n c rea sed u e tot he -4- EXHIBIT A c /'""",, J ~ needed .ncreases In personnel. wages and new fates set by the In~uranc~ commISSioner Our bad debt expense WI I I cont ,nue to be the most drama!,c cost Increase. Bad deb t ex pen s e " a comb' n at, 0 n 0 I un c 0 I I e c t , b I e accounts (true bad debt) and contractual d,.al lowances made by Med.-Cal, Medicare, and the local Indigent program. Ou r true bad debt ,ncreased dramat.cal Iy over the past two year. i h I ~. Increase wa5 caused by new billing st lpulatlons and compl.Cdt Ions bU' It 'nto the Med.-Cal and Med.care progrems. 1!1 I)rdel to tl)ee t t hi. c h e I I en 9 ewe pur c has e d a new b' I I , n 9 c omp ute ran d (j 0 ubi e d our oll,ce stall. At pre s e nt, un c 0 I I e c t , b I e s r e pre S e n t 29% "f 0 u r total patIent load. We pro J e c t _ red u C I n 9 t hat I, g u r e to 16% w, t h It, e new b, I I 'Rg system. Although true uncollectlbles w,lI be reduced sUbstant'ally. the bad deb t ex pen sew j I I I n ere a set 0 47% 0 f 9 r os S 5 a I e s due to bud get cut 5 . freezes or reductions in the variOUS governmental pay sources. The f 0 I I ow I n 9 I 5 a c h art 0 t 8: v era 9 e d I 5 a I Iowa nee 5 t rom d Iff ere n t programs based on current and new rates. Current Rate Increa5ed Rate Medicare Med,-Cal Med,-Med, County 36% 60% 49% 65% 15% 70% 47% 71% -5- EXHIBIT A c ~ . , v J Bad debt expense continues to be a major Dfot.1em fOI al h e ~ I t h care providers. The patIent mI. (the blend of pr lvate. medl-tal medi-medi. medicare. Indigent and uncollectIble) IS based ~tr I~tly on the SOClo-economlCS of the service communi ty as wel as the providers abl I Ity and WI I I I~gne~s to serye al I patients or refuse to serve low pay/no pay patl~~ts Just recently the San Bernerd,no County Hospital w.thdre'N ,t', Medl-Cat contract tor Inpatient services with the state The county fet tit needed to take action because the state was paYing below cost A It he. ugh faced with the same Issues. we WI I I not r~tuse s~rvlce from a mordl ethical or I iab. I Ity standpOint RATE INCREASE EFFECT The reQuested rate Increase WI I I " t~le average charge from $224.07 per patient to S26437 ~r"c" 5 a:'". ~ B% I n I, rea 5 e t n rat e:;, Based over the last 2 years that reprt~ents a le&s than 9% IflcreSS0 per year, The fol lOWing illustrates that Increa'~ Charae Increase Fa c tor Net Increase Response Emergency MI I eage Times Night/Weekend $23,08 $10.85 S 1 19 $ 2, 18 S 6.97 98% 58% .L 6'~ 1% 48% S23 40 S 6.25 $ I 14 $ .02 S 3.45 -6- EXHIBIT A c (1 ~ o ) Since our cost per call will escalate to 1308 8b IncludIng prof I t by the end 0 f Ma y. 1988. we w I I I nee d a n add,., 0 n d I $ 4 4 ') 1 P ~ rea I In order to generate the addl t lonal sale5 we are prepar log to (.harye for advanced I ,fe support serv,ces as regulated by the County It 15 our intent to charge those who ut I I lze the special serVice! and maXimize third party payment for ~uch services as opposed to exorbi tantly raising the basIc rates t(l 31 I consumers whICh WI I I have strong negat.ve ,mpact on low ,ncome pat,ent, We are the only commercial ~ervlce In the area currently providing advanced ife support services w, thout charging for such. The requested rate .ncrea.e coupled w, th county regulated advanced I,fe support charges ,s a pari ty adlustm.nt ,n rates which w, I I br 'n9 the company back ,nto a profl pOSlt!G1'" ::r~d allow growth In technology and al low us to continue malntalnl~g high In~ustry service standards -7- EXHIBIT A c' - o o J SUf'PORT '!iIl.~6 r h e f 0 I low I n 9 d 8 t a I s e rt c I (I ~ e d t () ~ u P P (d f t tl f:' :" t ': I fI l 1 .:.J '- - P a yme n t 0 IS I " b u I ,on 2 Pro J e c t e d P a yme n I () lot riD uti (> n 3. Operations Income and Expeno:.e ~ti3fer'r~r"l1. 4. Schedules to Operat Il1Q EAo~n5l! 5. Projected Incon's and ((p~n~e ;,~t~m~"t 6 Projected Schedult:~ of ()~eratlnq E/(;er,~~ 7. Comparative Rate SUlvey -8- EXHIBIT A c o o PAYMENT DISTRIBUTION SAN BERNARDINO CITY 2/88 through 1/87 RATE PATIENT PATIENT POPULATION DISTRIBUTION Kaiser 1038 8.0% Private 1817 14.0% Medi-Cal 1298 10.0% Medi-Medi 2596 20.0% Medicare 908 7.0% County 1557 12.0% Uncollectable 3764 29.0% ------ ------ Totals 12.978 100% :> AVERAGE PAYMENT 1253.01 207.53 89.87 112.72 144.24 79.56 o TOTAL SERVICE AREA 2/86 through 1/87 RATE PATIENT PATIENT AVERAGE POPULATION DISTRIBUTION PAYMENT Kaiser 132 1 7.5% 1251.34 Private 2730 15.5% 212.86 Medl-Cal 176 1 10.0% 96.08 Medi-Medi 3258 18.5% 121.08 Medicare 132 1 7.5% 143.66 County 2289 13.0% 85.54 Uncollectable 4931 28.0% 0 ------- ------ To t a I s 17.811 100% -9- EXHIBIT A c /""\ U o :> PROJECTED PAYMENT DISTRIBUTION RATE Kaiaer Private Medi-Cal Medi-Med, Medicere County Uncollectable Totals RATE Keiser Private Medi-Cal Medi-Medi Medicare County Uncollectable Totals SAN BERNARDINO CITY 2/86 through 1/87 PATIENT POPULATION 110 1 1926 2202 3165 1514 1650 2202 13.760 TOTAL SERVICE AREA PATIENT POPULATION 1463 2987 2800 4480 1493 2427 2988 18.668 -10- PATIENT DISTRIBUTION 8.0% 14.0% 16.0% 23.0% 11.0% 12.0% 16.0% 100% PATIENT DISTRIBUTION 8.0% 16.0% 15.0% 24.0% 8.0% 13.0% 16.0% 100% EXHIBIT A c o o COURTESY SERVICES OF SAN BERNARDINO, INC. Operetlons Income & Expense Statement 12 Months EndIng February 1987 SALES COST OF SERVICES Ambulance Repair & Maintenance Gas & 0, I Deprec,at ion Expense Ambu lance Supp I' es Employee Training Radio Expense Ambulance Wages Ambulance Payrol I Taxes TOTAL COST OF SERVICES GROSS MARGIN Less: Operating Expenses INCOME FROM OPERATIONS OTHER INCOME (EXPENSE) INCOME BEFORE TAXES -11- S4.080.412 105.518 60.843 67.213 48.315 1 1 . 173 12. 187 820.341 61.839 Sl.187.429 2.892.983 3.146.498 (1253.515) S49.742 (S203,773) o EXHIBIT A c '" u o COURTESY SERVICES OF SAN BERNARDINO. INC. Schedules to Operating Expense \2 Months Ending February t987 ACCOUNTING ADVERTISING BAD DEBT EXPENSE BUSINESS PROMOTION CASHCOVER AND SHORTl COLLECTION EXPENSE CONTRIBUTIONS DEPRECIATION & AMORTIZATION DUES AND SUBSCRIPTIONS EMPLOYEE WELFARE INSURANCE INTEREST LEGAL LICENSES AND FEES MEETINGS & CONFERENCES OFFICE EXPENSE OUTSIDE SERVICES RENT REPAIRS AND MAINTENANCE SALARIES TAXES - PAYROLL TAXES - PROPERTY TELEPHONE UTILITIES TOTAL OPERATING EXPENSES -12- 49,785 9,745 \,9\7,27\ 2,744 20 5\ ,968 26,94\ 45,102 25,946 74,448 94,739 29,551 7,014 \\ ,331 33,696 88,253 32,559 66,764 26,737 44\,465 45,627 10,155 30,607 24,030 -3.146,498 ---------- ---------- :) EXHIBIT A o r"" V o COURTESY SERVICES OF SAN BERNARDINO. INC. PROJECTED INCOME & EXPENSE STATEMENT 12 Months Ending May 1988 SALES COST OF SERVICES Ambulance Repair & MaIntenance Ga s & 0 i I DeprecIation Expense Ambulance Suppl ies Employee Training Radio Expense Ambulance Wages Ambulance Payrol I Taxes TOTAL COST OF SERVICES GROSS MARGIN Less: Operating Expenses INCOME FROM OPERATIONS OTHER INCOME (EXPENSE) INCOME BEFORE TAXES -13- 15.166.216 84.400 68.451 123.896 69.042 11.113 16.234 1.004.102 85.349 11,462.646 4.303.510 4.019.442 1224.128 1224.128 :) EXHIBIT A o ", '...,) o COURTESY SERVICES OF SAN BERNARDINO. INC. PROJECTED SCHEDULES OF OPERATING EXPENSE 12 Months Ending May 1988 ACCOUNTING ADVERTISING BAD DEBT EXPENSE BUSINESS PROMOTION CASH(OVER AND SHORT) COLLECTION EXPENSE CONTRIBUTIONS DEPRECIATION & AMORTIZATION DUES AND SUBSCRIPTIONS EMPLOYEE WELFARE INSURANCE INTEREST LEGAL LICENSES AND FEES MEETINGS & CONFERENCES OFF I CE EXPENSE OUTSIDE SERVICES RENT REPAIRS AND MAINTENANCE SALARIES TAXES - PAYROLL TAXES - PROPERTY TELEPHONE UTILITIES EMPLOYEE RETIREMENT PLAN TOTAL OPERATING EXPENSES -14- 29.500 9.000 2.606.822 5.704 28.521 16.340 64.486 29.936 77.936 170.741 59.102 8.785 10.096 27.984 75.000 31.250 74.568 19.200 562.428 38.440 10. t 55 32.607 28.836 40.000 14,079.442 ----------- ----------- :> EXHIBIT A o u "0 WW .."e we.. :..e ~c: ....u ww 00 _z.. "Oe w..: ..u w .. uww -"0 oz.. wOe "..: e0u ..w c.. .. z w e ~ " o 00 O. O~ ~~ w " ~ U Z w e .. w " w 00 00 O. ~~ - a z w e e w ~ " w > .. ~" ~ - eu z z o - e ~ U ..0 "0 .. wO "N . o .. N .. " o :0 o .. w. ..- 00 O. _0 ,0 - o ..~ .. " ~ O~ ~~ ON O~ .- o o . .. o - . .. o o o - - " w > w U > ~.. ~w z.. " Ow uu.. z- "e.. ,,~. ..", U.... ".. ee_ ~ . z-. e , 0 ..c. z " 0.. uu -.. e",o ..w. e". ~e' u.... e.. e.... ~ . z>. euo ....- .. o ~ zo i~ ,. :- > .. w "0 wo ~ wo -.. o o o . z " .. -0 o .. . wo ..~ o o o . o o o . _0 '0 - o ..- .. " o : o o - o o o - o o o ~ N w >.. ~- z.. "" Ow u - - . . "'_N co.... ~ef'? za;~.... o..,~o .IE..... z " . -0 o .. WO "N o o .. o o o . o o o N o o o . .. w .. ~ wo .... .. .... a. e a ~ .. .. e : ~ e -.. UN w ... ..- o o . N .. " o o o .. .. -. N .. w. ..- .. N _0 '0 - o .... .. " o : -. , N - . ..- .. " o : o o - o o .. ~ o o .. N N w u > .. w .. > ~w zu "z oe U~ ,,- ..... w,,- ~e. w , "z_ Zw.. e.... .., ..-. 0"- ~u.. w u >z ~e ..~. "".. 0... u,,_ e. e .. ...... "w. ~a' z".. w..o >.... o .. N .. a " .. -0 o .. wo "N .. o "0 ~ "0 ~ ~ ~ a o _0 '0 - o ..~ .. " o : .. N - o .. .. o o o .. ~ N o o . N o .. .. .... WN o .. .. .. .. .. o :0 . .. . wo ... .. .. .. .. _0 '0 ..~ .. " o : o o . o o o N o o .. - N w u a e ~ " >.. ~".. aeo " .. 0-. u..' w.. e..- "0. w~, ...... e_o ".... w u > .. w >.. ~ aw u:: ue_ ~N ..", ~I: wc- ~ , a-" i~: .. " 0.. z._ ...... w~~ ....e o o o .. _0 '0 - o ... .. " o : o - .. .. .. - o o . .. .. .. >e" ~..- ae.. "a' o _ u.... .... ew' ..a- e-o ....- -15- o o .. .. o o o o .. - o o o .. ~ w u z e ~ " .. " e w >u ~a ze ,,~ 0"" ul: we.. .. , -.~ ..w_ ..z_ w.., >o~ -0- ...... o . .. .. .. N .. " 00 :0 . "0 WN .. .. .. . .. N . _0 '0 . o ... .. " o : .. .. o . .. o o o . ~ N w >u ~z ae ,,~ o,,~ u..- ,,~ we- o , -..- ....N "a~ w-, ...... -..- ..... o o o .. .. " o :0 o .. wO .... o o .. - - .. , N - . "N .. " .. : .. N o o o .. o o . - ~ w >u ~z ae ,,~ 0" u... "0 oe- ~ - z~' w~.. ,,-- e:~ ..~, uo. cO- ...... . . .. - . N o .. .. o o . .. o o . .. N > ~ z " o Uw U oz ze -~- "'".. ..... e". ze' .. . w~. ....N W' ...... ew- "0" . .. o o .. ~ . . N o o o .. o o .. ~ . . ~ . o o o .. - ~ o o 0 o .. .. . o o o 0 o 0 . - .. .. - ~ .. .. ~ w u a >oe ~ ~ a" ".. 0" .. ue 0" . ~. .., , ..,Z(,>O -0-_ 000>" ~.. , 2&,11.I_ ee.. ..: . a " .. -0 o .. w~ ..- o o o - _0 '0 - o ..- .. " o : 00 00 0.. -.. NN e .. w " e ~ w u a >oe ~~ Z" .... 0" ue oz ueo ..uo - -- u..- zw' e"- ..e~ ..... e, aa.. e-- ..c. EXHIBIT A :> .. e \!o ,",0 .... -.. o o o o e c" w.. o .. N ~ - ~ o o ~ N o o o o o . o o o . - ~ ~o .0 - - ..~ .. " o : ~o ,. - N ..- .. " o : o o o o . - . o o o o o N . N o o .. N o o o o o o .. ~ ~ o ~ . . N u z > ~ z " ow uu a oe ..~ .." -.. "" oe >ow ~u az "e o~ u" ..~ z".. -c. " 0>' e~~ 0-- -u.. , a~" c~o "eN . . , W' 0.UI ___fI ~::.>.. .......et.. w' Z Z celli e e . .... . . 0 . . ('") DEPARTMENT OF FUULlC ; ....: .~'rR o """v' "'% ......." '/,/ ~ '~ -:= . =- 00;;.. , ~ ,.~ ~.... /1f'/111\\\~' :> COUNlY OF SAN BERNARDINO . ,," ,"';"_"'''~d t<r>~~.~""\ "~~......,~;~..:1....-.~~. ~. '-"~:'oo":"~"'" ~1C'~,.... '_ ,,- ~~..o.:ll 351 NCH1h Mt. IIIew Avenue' Sill Bernardino. CA 9241&-0010 . 17141387.6280 GEORGE R. PETTERSEN, M.D.. M.P.H. Director of Public H..lm June 2, 1987 Terry L. Russ, Treasurer Ambulance Association of San Bernardino County P.O. Box 934 San Bernardino. CA 92401 Dear Mr. Russ: I have reviewed your application for. ambulance service rate adjustment dated May 26, 1987. After doing the computations specified in the formula approved by a Resolution of the Board of Supervisors on April 23, 1984, a revenue change of less than 10 percent would result, actually a .86% change in revenue, The new average revenue for full-pay response would allow an increase of $7.12, Computati~ns following the formula yield the following results: '. Base Rate Mileage Emergency Night Oxygen Time Rate ALS Base EKG All inclusive ALS Service I . $143.88 7.19 65,35 41.97 17.99 13,18 218,83 29,97 324.83 . 1 " The new rates shall become effective June 19. 1987. I would call your attention to the ambulance ordinance, Section 31.0819(g)(3) , that requires pernrittees, within 10 days of the effective date ,of the new rate, to publish these rates in a newspaper of general circulation'in their service area once a week for two weeks. .. ~mJ~~ :. '- GE GE . PETTERSEN, M.D. Di tor of Public Health GRP:al cc: Ambul ance Provi ders City Managers EXHIBIT B