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From:
Dept:
Date:
CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTIO
Mat Fratus, Deputy Chief
I.J ii'
Subject: Resolution adopting Amendment Number One to the
Emergency Ambulance Transportation Services
Subcontract Agreement between the City of San
Bernardino and the American Medical Response
Inland Empire.
Fire
October 30, 2008
MC/C Meeting Date:
November 3, 2008
Synopsis of Previous Council Action:
01/29/01
03/06/00
07/19/99
04/19/99
Resolution #2001-27 approving a long term contract between the Fire Department and American
Medical Response regarding enhanced pre-hospital paramedic service.
Resolution #2000-45 approving 120-day extension for pre-hospital paramedic service pilot program,
as set forth in the contract with American Medical Response Inc.
Resolution #1999-186 authorization to enter into a 180-day pilot program regarding enhanced pre-
hospital paramedic service.
Fire Department and American Medical Response staff presented information regarding the subject
issue, at a workshop to the Mayor and Common Council.
RECOMMENDATION:
1. Adopt resolution, and
2. Authorize the Finance Director to amend the FY 2008-2009 Adopted Budget to increase General Fund revenue
account 001-000-4881 (Paramedic Reimbursement) by a net $38,900 from $359,100 to a new total of $398,000
and increase the Fire Department General Fund expenditure budget in account #001-201-5609-0000 (Vehicle
Replacement) by $38,900 and appropriate $45,900 from the available Fire DIFF fund balance into account 262-
482-5609 (Vehicle Replacement) and do the corresponding budget adjustments in the Fleet Fund for the purchase
of a new Paramedic Squad Vehicle as outlined in the staff report.
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Signature
Mat Fratus. Deputv Chief
Phone: (909) 384-5286
Contact Person:
Supporting data attached: Staff Report. Resolution. and Agreement
Ward: Citv Wide
FUNDING REQUIREMENTS:
Amount:
Source:
$398.000
(Acct No.) 001-000-4881
(Acct. Description) Paramedic Reimbursement
Council Notes:
Finance:
A-::;,,:> 2<::>08- '/tJ8
Agenda Item No._1 c.t
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STAFF REPORT
SUBJECT
Resolution adopting Amendment Number One to the Emergency Ambulance
Transportation Services Subcontract Agreement between the City of San Bernardino and
the American Medical Response Inland Empire.
BACKGROUND
On January 22, 2001, the Mayor and Common Council authorized the execution of a
long-term contract with American Medical Response (AMR) regarding enhanced pre-
hospital paramedic services. Through this partnership, both parties established a contract
outlining a mutually agreeable approach to providing enhanced basic and advanced life
support services to the citizen of San Bernardino. In addition to providing improved
services, the contract's provisions created a decrease in operating costs for AMR. Those
cost savings were split between the two agencies; 60% going to the City and 40% to
AMR. The City's portion of this savings is $259,128.84 annually.
The contract continues to benefit both agencies and the citizens of San Bernardino.
However, as operating expenses increased, it became necessary to review the amount
saved through the contract, reevaluate the contract language, and make appropriate
changes. The Fire Department and AMR have met on these issues and negotiated an
amendment to the contract that reflects contract savings based on AMR's current
operating costs. The amendment will increase the city's portion of the annual base
compensation to approximately $395,300 (rounded). This amount will be reviewed
annually and adjusted based on changes in AMR's operating costs. In addition, the
original contract provides for a one-time retroactive payment to the City of$57,841 from
January 1,2008 through June 30, 2008.
The original contract is performance based. It requires that the Fire Department respond
to all emergency medical service (EMS) calls in 7 minutes, 59 seconds or less on 90% of
the calls for service. This performance standard is required by Inland Counties
Emergency Medical Authority as part of this agreement, and will not change with this
amendment. Adherence to this performance criterion will be challenging for the fire
department as call volumes continue to increase and additional strain is placed on
existing response systems. The amendment specifies a penalty of $27.00 for each call that
the City falls below the 90% compliance standard. In addition, for each call in the month
below the eighty-five percent (85%) compliance where the City fails to meet the
Response Time Compliance Standard, AMR may increase the per call penalty amount to
fifty-four dollars ($54.00) per call. The City will not be required to pay any penalty
amounts that are greater than the value of the contract. However, calls for service with
response times that fall below the standard will result in penalty fees, which will decrease
the City's net revenue from the contract.
Currently, approximately 7% of the Fire Department's calls for service are falling below
the 90% threshold. Therefore, the actual revenue that the City will receive for FY
2008/2009 is estimated to be $340,200. The Fire Department is currently taking steps to
improve these response times. These steps include purchasing a new fire station alerting
system, improving call-processing procedures in Fire Dispatch, and managing resource
allocation throughout the city. As these steps decrease response times, the amount of
revenue realized by the City will increase up to the full amount of the base compensation
for contract.
One step that the Fire Department will need to take to help ensure that this performance
standard is met is to purchase a reserve paramedic squad vehicle. The City purchased a
new paramedic response vehicle in 2007 to accommodate the addition of a two-person
paramedic squad at fire station 226. The vehicle is the only one of its type in the fire
department. In order for the paramedics to respond 24/7, it is necessary to have a reserve
vehicle to accommodate regular maintenance on the primary vehicle, and to provide back
up in case the primary vehicle breaks down. The estimated cost for a reserve paramedic
squad is $84,800. The Fire Department is proposing to fund this purchase by using some
of the one-time retroactive payment from AMR, along with approximately $45,900 from
Fire's Development Impact Fee Fund (DIFF), as this is an eligible use of the funds.
The amended agreement replaces Section 12, Section 27, adds Section 25, and deletes
Section 1.5 and is replaced with a new Section. All other terms and conditions of the
agreement remain unchanged. Since implementation date of the amendment has passed,
the resolution ratifies any action taken from July I, 2008 through the date that the
agreement is executed.
FINANCIAL IMPACT
AMR will pay the city an annual base compensation of$395,263.75 for the period of July
1,2008 through June 30, 2009. The base compensation shall be paid in equal monthly
installments less any penalties for the preceding month. The Agreement has a caveat that
the base compensation will be adjusted (either increased or decreased) July I st during
each year of this Agreement. The total compensation amount from this contract will be
adjusted annually to reflect changes in AMR's operating costs.
The City's share of the cost savings that will be realized through this amendment will
increase from the FY 07-08 amount of $259,100 (rounded) to approximately $340,200
for FY 2008-2009. This is a net annual revenue increase of$81,100 for the City. In the
FY 2008-2009 Adopted Budget, Fire projected that the renegotiated contract would result
in an annual revenue increase of $100,000. So therefore a revenue budget of $359,100
was approved in final FY 08-09 Budget. There needs to be an adjustment to the budget
to reflect only $81,100 due to the projected penalties the city on Response Time
Performance Penalties.
In addition, the City will receive a one-time retroactive payment of $57,841 for their
share of the cost savings that occurred from January 1, 2008 through June 30, 2008.
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Therefore, the combined revenue projected for FY 2008-2009 is $398,000 ($395,200
minus $55,000 projected penalties plus $57,800 one-time payment).
A budget amendment is needed to show the estimated revenues and to allocate these
funds appropriately. Fire is requesting that the funds generated from this agreement fund
the purchase of a reserve paramedic squad. Also, that the cost difference to purchase a
new reserve paramedic squad come from the Fire's Development Impact Fee Fund. The
Fire Department will bring back to Council for approval the award of contract to the
vendor selected to purchase the reserve squad.
RECOMMENDATION
I. Adopt resolution, and
2. Authorize the Finance Director to amend the FY 2008-2009 Adopted Budget to
increase General Fund revenue account 001-000-4881 (Paramedic Reimbursement) by
a net $38,900 from $359,100 to a new total of $398,000 and increase the Fire
Department General Fund expenditure budget in account #001-201-5609-0000
(Vehicle Replacement) by $38,900 and appropriate $45,900 from the available Fire
DIFF fund balance into account 262-482-5609 (Vehicle Replacement) and do the
corresponding budget adjustments in the Fleet Fund for the purchase of a new
Paramedic Squad Vehicle as outlined in the staffreport.
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RESOLUTION NO.
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RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO ADOPTING AMENDMENT NUMBER ONE TO THE
EMERGENCY AMBULANCE TRANSPORTATION SERVICES SUBCONTRACT
AGREEMENT BETWEEN THE CITY OF SAN BERNARDINO AND THE
AMERICAN MEDICAL RESPONSE INLAND EMPIRE.
BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO AS FOLLOWS:
SECTION 1. On January 29, 2001 the Mayor and Common Council adopted
Resolution NO. 2001-27 authorizing the city to enter into a long-term contract with American
Medical Response for enhanced pre-hospital paramedic service;
SECTION 2. That the City of San Bernardino and American Medical Response Inland
Empire request authorization to amend said January 29,2001 contract;
SECTION 3. The City Manager or designee is hereby authorized and directed to
execute said amendment to the January 29, 2001 contract, a copy of which is attached as
Attachment A;
SECTION 4. Said amendment shall be effective when executed by all parties and the
effective date shall be July I, 2008; therefore, any action taken between July I, 2008, and the
date that the agreement is executed is hereby ratified.
SECTION 5. The maximum amount of compensation paid to the City through said
amendment shall be three hundred ninety-five thousand, two hundred and sixty-three dollars
and seventy-five cents ($395,263.75) for the period of July I, 2008 through June 30, 2009.
The base compensation shall be paid in equal monthly installments less any penalties for the
preceding month. The Agreement has a caveat that the base compensation will be adjusted
(either increased or decreased) July I st during each year of this Agreement.
SECTION 6. The authorization to execute the above referenced amendment IS
rescinded if the parties to the Agreement fail to execute it within sixty (60) days of the
passage of this Resolution.
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IIII
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO ADOPTING AMENDMENT NUMBER ONE TO THE
EMERGENCY AMBULANCE TRANSPORTATION SERVICES SUBCONTRACT
AGREEMENT BETWEEN THE CITY OF SAN BERNARDINO AND THE
AMERICAN MEDICAL RESPONSE INLAND EMPIRE.
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I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and
Common Council of the City of San Bernardino at a
meeting thereof, held on
the
day of
, 2008, by the following vote, to wit:
COUNCIL MEMBERS:
AYES
ABSTAIN ABSENT
NAYS
ESTRADA
BAXTER
BRINKER
DERRY
KELLEY
JOHNSON
MCCAMMACK
Rachel G. Clark, City Clerk
City of San Bernardino
The foregoing Resolution is hereby approved this
day of
,2008.
Patrick J. Morris, Mayor
City of San Bernardino
Approved as to form:
JAMES F. PENMAN, City Attorney
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AMERICAN MEDICAL RESPONSER
FIRST AMENDMENT TO EMERGENCY AMBULANCE TRANSPORTATION SERVICES
SUBCONTRACT AGREEMENT
THIS FIRST AMENDMENT TO EMERGENCY AMBULANCE TRANSPORTATION SERVICES SUBCONTRACT
AGREEMENT ("Amendment") is made between American Medical Response Inland Empire ("AMR") and the City of San Bernardino (the
"City").
WHEREAS. the parties wish to amend the Emergency Ambulance Transportation Services Subcontract Agreement that they entered January
29,2001 ("Agreement"); and
WHEREAS, the parties wish to amend the Agreement on the terms and conditions set forth herein.
NOW THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt and sufficiency of which
arc hereby acknowledged, the parties hereto agree as follows:
This Amendment shall be effective when executed by all parties and the effective date shall be July 1, 2008.
2. The parties hereby delete Section 12 of the Agreement in its entirety and replace it with a new Section 12 set forth below:
12. BILLING AND PAYMENT:
A. Base Comoensation: Base compensation is determined by calculating the total unit hour costs (average field employees' hourly
wages and related benefits cost) savings that AMR realizes from the increased response times that AMR receives from the County when
the City provides first response ("Unit Hour Savings"). The Unit Hour Savings realized by AMR for the preceding calendar year will be
split sixty percent (60%) to the City and forty percent (40%) to AMR. AMR shall pay to the City annual base compensation of Three'
Hundred Ninety-Five Thousand, Two Hundred and Sixty-Three Dollars and Seventy-Five Cents ($395,263.75) for the period of July I,
2008 through June 30, 2009. The base compensation shall be paid in equal monthly installments less any penalties for the preceding
month as set forth herein. .
B. Base Comoensation Adjustments:
The base compensation will be adjusted (either increased or decreased) July 1 Sl during each year of this Agreement. The adjustment will
be calculated by determining the Unit Hour Savings realized by AMR for the preceding calendar year split sixty percent (60%) to the
City and forty percent (40%) to AMR.
Example:
AMR's hourly wages and related benefits cost is $25 per unit hour and AMR saved 10,000 unit hours
in 2007_ The annual base compensation to the City beginning July 1,2008 would he $150,000, i.e.,
$25 X 10,000 unit hours X 60%
The adjustment will be determined by AMR and the calculation provided to the City no later than June 1st of each year of the
Agreement.
C. Conditions to Base ComDensation: The base compensation and Agreement are solely contingent on ICEMA's continued approval of
AMR's current increased response time requirements within the City Zone which permit AMR to respond to all 9-1-1 PSAP originated
emergency medical responses within eleven minutes and fifty-nine seconds (11 :59) or less 90% of the time. Further, the City warrants
and represents that the base compensation is, and shall be at all times, less than or equal to its actual costs to provide the first response
services to AMR.
3. The parties hereby delete Section 27 of the Agreement in its entirety and replace it with a new Section 27 set forth below:
27. DEFAULT:
A. AMR may terminate this Agreement immediately by providing the City with written notice if any of the following defaults occur:
1. The City fails to meet response time requirements for any three (3) consecutive months or four (4) months in any rolling
twelve (12) month period; or
7.1.08 First Amendment To Agreement
Confidential and Proprietary
Attachment "A"
2. The continuation of services by the Cit) would, in AMR's reasonable determination, create an imminent threat to the
health, safety or \'ielfare of patients.
B. AMR may tenninate this Agreement immediately by providing the City with written notice jfthe City fails to cure any other default
under the Agreement after receiving notice from AMR of the default and a thirty (30) day period to cure.
C. The rights and remedies of AMR provides in this Section shall not be exclusive and are in addition to any other rights and remedies
provided by la\\-' or under this Agreement.
4. The parties hereby add a new Section 35 to the Agreement as set forth below':
35. REGULATORY:
A. Comnliance. The parties will comply in all material respects with all applicable federal and state laws and regulations
including, the federal Anti-kickback statute.
B. COffioliance Prollram and Code of Conduct. AMR has made available to each party a copy of its Code of Conduct:, Anti-kickback
policies and other compliance policies, as may be changed from time-to-time, at AMR's web site, located at: www.amr.net:. and each
party acknowledges receipt of such documents. AMR warrants that its personnel shall comply with AMR's compliance policies,
including training related to the Anti-kickback Statute.
C. Non-Exclusion: Each party represents and certifies that neither it nor any practitioner who orders or provide Services on its behalf
hereunder has been convicted of any conduct that constitutes grounds for mandatory exclusion as identified in 42 U.S.C.9 1320a-7(a).
Each party further represents and certifies that it is not ineligible to participate in Federal health care programs or in any other state or
federal government payment program. Each party agrees that if DHHS/OIG excludes it, or any of its practitioners or employees who
order or provide Services, from participation in Federal health care programs, the party must notify the other party within five (5) days
of knowledge of such fact, and the other party may immediately tenninate this Agreement, unless the excluded party is a practitioner or
employee who immediately discontinues ordering or providing Services hereunder. The City shall screen its employees that provide
patient care services against the GIG's exclusion list on an annual basis and certify to AMR that its employees have successfully passed
the screening.
D. Referrals: It is not the intent of either party that any remuneration, benefit or privilege provided for under the Agreement shall
influence or in any way be based on the referral or recommended referral by either party of patients to the other party or its affiliated
providers, if any, or the purchasing, leasing or ordering of any services other than the specific services described in this Agreement.
Any payments specified herein are consistent with what the parties reasonably believe to be a fair market value for the services
provided.
5. The parties hereby delete Section 1.5 of Exhibit A to the Agreement in its entirety and replace it with a new Section set forth below:
5. ReSDonse Time Performance Penalties.
A. Per Call Penalties. For each call in the month below the ninety percent (90%) compliance where the City fails to meet the Response
Time Compliance Standard, AMR may assess a per call penalty in the amount of twenty-seven dollars ($27.00) against the City. For
each call in the month below the eighty-five percent (85%) compliance where the City fails to meet the Response Time Compliance
Standard, AMR may increase the per call penalty amount to fifty-four dollars ($54.00) per call.
Illustration: For a month where the City responds to a total of 100 calls and is on time for only 83 calls, AMR may assess Per Call
Penalties in the amount of$243 for the 7 calls where the City was below 90% -- $243 ~ ((5 X $27) + (2 X $54)).
The amount of the penalty in any given month will never exceed the amount of compensation that AMR pays to the City, e.g., a $10,000
monthly payment to the City equals a maximum of a $10,000 penalty -for the month, and no penalty will be assessed when the 90%
Response Time Compliance Standard for the month is met.
6. All other terms and conditions set forth in the Agreement remain unchanged.
[Signature page follows]
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FIRST AMENDMENT TO EMERGENCY AMBULANCE TRANSPORTATION SERVICES
SUBCONTRACT AGREEMENT BETWEEN
AMERICAN MEDICAL RESPONSE AND THE CITY OF SAN BERNARDINO
IN WITNESS WHEREOF, the parties have hereto executed this Amendment.
Dated:
American Medical Response of Inland Empire
By:
Kurt Williams, DCOO
Dated:
City of San Bernardino
By:
Mark Weinberg, Interim City Manager
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