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Home My WebLink About34-City Clerk . ,\ CITY OF SAN BERRRDINO ,4V'REQUEST FOR COUNCIL ACTION -.om: Lee Gagnon, Business Liceft,Sf:CSupJr\ri~6t f&.bJect: --':1 Authorize Franchise to Operate Dialysis Transportation Service--- Healthlink. Oept: City Clerk r:---.:\ Date: March 8, 1990 Synopsis of Previous Council action: 5/28/81 -- Approved franchise for Care Ambulette Service, Inc. to conduct dialysis transportation within the City of San Bernardino. 8/19/85 -- Approved franchise for Southwest Medical Transport, Inc. to conduct dialysis trans- portation within the City. Recommended motion: That Healthlink be granted franchise to operate two dialysis transportation vehicles in the City of San Bernardino under the provisions of Municipal Code Chapter 5.76. ......r )1[[' (. I ~, ~--,.;/~-?,..<' <" Signature --- Contact person: Lee Gagnon Phone: 384-5036 Supporting data attached: Yes Ward: FUNDING REQUIREMENTS: Amount: Source: (Acct. No.) (Acct. Description) Finance: -'uncil Notes: 75-0262 Agenda Item No :3 J./ CITY OF SAN BERN~DINO - REQUEST F"~ COUNCIL ACTION STAFF REPORT The current dialysis transportation provider, Care Ambulette Service, Inc., was granted a franchise on May 28, 1981 to transport dialysis patients to and from San Bernardino Valley Dialysis Center located at 1500 North Waterman Avenue in the City of gan Bernardino. The franchise permits Care Ambulette Service, Inc. to operate two dialysis transportation vehicles within the City. On August 19, 1985 Southwest Medical Transport, Inc. located at 1802 East Cedar, Suite A, Ontario, California was granted a franchise to operate three dialysis transportation vehicles. How- ever Southwest Medical Transport, Inc. subsequently went out of business leaving Care Ambulette Service, Inc. as the sole provider. At their meeting of February 13, 1990 the Bureau of Franchises recommended that a second dialysis transportation provider, Health- link, located at 11175 Mountain View, Suite L, Loma Linda, California be granted a franchise to operate two dialysis transportation vehicles. The Bureau of Franchises based its recommendation on testimony by social workers from Lorna Linda University Medical Center and letter of recommendation by Dr. Kovalich, Medical Director of the San Bernardino Valley Dialysis Center. The Bureau of Franchises also placed a high priority on what would be most beneficial to the dialysis patients. The two dialysis transportation franchises would provide patients with a choice of providers. Consideration was given to the competitive aspect of having two dialysis transportation providers and the positive effect this would have regarding service. Healthlink owners Mr. Gary Fritzsche and Mr. Leo Castillo have complied with all requirements set forth in Municipal Code Chapter 5.76 relative to dialysis transportation. This includes proof of insurance and payment of the franchise permit filing fee. Rates for dialysis transportation charged by Healthlink will be the rates established by the Medi-cal Program of the State of California. 75-0264 HEALTHUNK APPLlCA TION FOR DIAL YSIS TRANSPORTATION FRANCHISE PERMIT IN THE CITY OF SAN BERNARDINO .~~,~...-... .~.__#,... ~_.,. CITY OF SAN BE~~ARDINO .-- . .r:. . "'" '--... C r- PETITIO:-l' FOR FRANCHISE PERMI' ! _ TYPE OF FRANCHISE REQUESTED Dialysis Transportation PRINCIPAL'S NAME Careo Ent. Inc. BUSINESS PHONE 370-0962 Ni\:.rE OF BUSINESS Health-Link , ADDP~SS OF BUSINESS 11175 Mtn. View Ste. STREET L Loma Linda Ca. 92354 CITY ZIP CCDE 0\'nj~?'" S RESIDENCE STREET CITY ZIP CODE Hor1E PHmrE II. IT FILING AS PARTNERSHIP, ASSOCIATION OR UNINCORPORATED Cm!PANY, CO:-'.PLET=: THE FOLLO\HNG INFOR:-lATION BY LISTING THE NAl-1ES OF THE PARTNERS C=<. PERSONS CO:'l?R1SING 'DE PARTNERSHIP, ASSOCIATION OR CCNPANY TOGETHER WITH THEIR P2SPECTIVE AGES IN AD~ITION TO PART I. NAME AGE 1. Gary Fritzsche; 11816.B::-ianrood['Ct.Loma Lindil ceil. q?1"i4 2. Leo Castillo; 1800 Fairfax Dr. San Bdnn. ceil g?404 3. 4. .. COF-.~RATION (IF FILING AS CJRPOR)..TION, CO:.1PLETE FOLLO~nNG W=OR.!-!ATION I:, 'ADDITION TO PART 1.) N~1E OF COR?OR~TION DATE OF INCORPOF~;TION Careo Enterprises Inc. Aoril -1987 PLACE OF INCORPORATION California ADDRESS OF PRINCIPAL PUCE OF BUSINESS 11175 Mtn. view Ste. L STREET Lama Linda Ca. 92354 CITY ZIP CODE ~~LS OF OFFICERS NAME STREET CITY ZIP CODE RESIDENCE ADDRESS 1. Gary Fritzsche; 11816 BriarwoodCt. Lorna easurer 2. Leo Castillo; 1800 Fairfax Dr. San Bdno. Ca. 3. 4. (IF ADDITIONAL SPACE NEEDED, USE SEPERATE SHEET) "-;'J-''''-'' '" ....., ",. .-_.' . - ;., . \/-:l"I"C':'L~S . . .~.. c..r !. _..{~,------~----.-....-.-.._._~...- _..._-_._~..__.---_._- ....---.--- - -. ;-.... * ,'~ ) CONuIT!O:-l OF VE:i!::~S l'ROPOSr ~O..,E OPERATED UNDER T~FE. ~O~SL,CAPACITY T:1IS FR"CHISE. Dodge Van 1987, equiped for two w/chairs & four ambulator assencrers Chpvy'Vrlf1 1QACJ, P11lip",rj for two w/I""hrlirs F. f(',llr rlmb1l1rltory prlSSPf1gers (r; ;,DJ!7IONAL Si'ACE ~:E::DEJ, use: 5::PER.;T::: 5=-=T) =-:~S;,:?_;;-iC :~;:/'::: 0= mSURA1KE co:,!?;'~'lYProgressive Casualty Ins. CO./Industrial Indemnity :::>::SC?!??IO~1 OF CO'!E?!\G:: Collision, comprehensive. POLICY 0;;7E Nov. 25/88 C::::::CLL8:: COpy 0: INSU?_,~;c::::::::',~?_;GE ',II':'H ";::;:S PETITION) ,-,-. S7AT:::'~';? OF ASS::TS ;'-"0 L:,'':::::'::-:::S 7:-i:: ?EJ:ITIONER IS RZQU:;;"::::; -:-: ,',7':'A01 A n:~ STAT=:'I:::';T OF HIS ;..sS:::S Al~ LIABILITIES. \;"~!. u::SC?IP'I'!O!i OF OPE?_:"7!C:; ~l T:lE SPACE P"OVIOEO B::::":',; S:::SG~3E Tj-:=:: O::::::?_:.:!'ION YOU ARE REQUESJ:ING TO :R.:~lCHISE AS \o2:.L ;'.5 ;'~;Y C:7:-':::~ r:r:OR:'L!\TIC: 'i::lU FE::L \oiILL HELP THE FR.!\NCHISE 3C.'_-=,D l'!.',XE A Dc:TE?;'lI~i.;7:::: ',;:,H RESPECT 'r-::: ::2?ROVING YOUR PETITIC;,j FOR A :R.;:jGlISE: PE:?HI7. We wish to transDor~ ::31,sis natients to LLUMC in Lorna Linda We are contacted wee~l! jy nursing homes, and other people wishing to use our Comcanv b~C3US~ of our qcod se~ice. Courtesy Ambu1ette in San Bernardino has r2:erred patients to our company when they have over flow. We at He3l:~-Link feel the increasincr nonulation warrants another Non emergency Medical Transportation Van service.If we can not recieve a Franchise for Non emerqency Medical Transoortation in San Bernardino please gran: Health-Link a permitt for us to tansport dialysis oatients to LLUMC. I can aive YOU refrences of nhysicians wanting to use our services. Because of our good services we continue to grow. 'IE. ?IL~IG pROCEDURE k.'ID FEZ FETITIO~ IS TO BE FILED \-IITH THE CITY CLE?.3:; BUSINESS LICENSE DIVISION, AT!'E~ITION. BUSINESS LICENSE SU?ERVISOR, 30e NORTH "0" STREET, SAN BERNARDINO, CALEOiU'HA 92418. AT OR BEFORE THE Tn-IE T.5IS PETITION IS FILED HITH THE FR~lCHISE BUREAU, THE PETITIONER SHALL PAY TO THE CITY OF SAN BER~A.qnINO A FILn:G FEE OF $590.00, PLUS ~lO.OO FOR E~C~ \~HICLE PROPOSED TO BE COVE?ZD EY THE PE::\!-lIT. (THIS IS NOT A BUSINESS LICE~jSE FEE) pr.:::.:l.SE READ AND SIGN: SIQlATURE 1 liE'rIT:tO~1 RE TRUE, ACCURATE AND C011PLETE. L'! I~; . CANCELLATION OF .2..HIS PETITION. 1U DATE -jAI-~ ;).5. let?;? , I CERTI:Y THAT AL FALSIFICATION 0 HEALTHLINK'S FORMATION Through the fall of 1986, Loma Linda Medical Center operated their own non-emergency transportation facility. At this point LLUMC came to the conclusion that financially, this method was not in their best interest. Both Gary Fritzsche and Leo Castillo were employed with Loma Linda Dialysis Center and were aware of the specific needs in the area of transporting of non-emergency patients. In December 1986, Mr. Fritzsche and Mr. Castillo began establishing the transporting business known as HEALTHLINK. This Loma Linda based business has been operating three years and has steadily built up its clientele. HEALTHLINK has established itself as a dependable and reliable service organization. :'.CASE ~EAC (CUR ~CLJ:'I POLICY NUMBER 0-4;-62-848-2 rIll!; t'eci.'lf.:11r,'ns PalJl~.~.m~ndeI1 OI:(;I=1'ilIIOn O,lI~" .....11" . JIIC\t tilCKf!1 It1t"111l'eo lw IMf' form ana \1<11110n (jate 'nc1lt;al~.<.t compleles !t1e .lOOve nllmbp.H1(j ool1C.V P~l:!""'\..'SlJOhl:vnn rllrm 1050 Ed 0986 *** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECT!VE 11/25/88 *** JEr 'A TIONS ~A....:D INSURED CASTILLO & FRITZSCHE PAGE 3 OF 5 HEALT~ Li~~r, 1 1 1 7 'i ~47 'oj! E w L l~MA-L!NDA CA 92354 Pol,cV pe;'"" 'c',. '"v STAND~PC T:ME AT Tf'E ADDRESS OF THE NAMED INSURED AS STATED HEREIN rKOM~lEC 7. 1988 TO NOV 25, 1989 ~ CLAUS HARRY KENNEY 247 E BASELINE SAN BERNARDINO CA 92410 WL-39326 pragfE1ffi/e cOmpaniBf PROGRE SS I VE CASUALTY I NSURANCE CO. 6300 WILSON MILLS RD. P.O. SOX 5070. CLEVELAND, OHIO 44101 -be Insura'1ce afforded IS only with respect 10 such antJ so many or Ihe follOWing coverages as are Indicated with respect to each described vehicle The limIt of the :Jl'npanys liabllttv against each suCh coverage snail be ,~s Slalea herein sublect 10 all the terms ot thiS potley havmg rp.lerence thereto SCHEDULE OF COVERED VEHICLES , JEH DR TRADE BODY DVR VEH TER RAD DSC DSC NO NO YR NAME TYPE SERIAL NO SCH CLS NO ZIP IUS COD PCT 1 -02 6 87 DODGE B250 VAN 2S4HB21T9HK220973 30 H06 59 92354 200 672 20 2-02 8 87 DODGE B250 VAN 2B4HB21T~HK224~60 30 H06 59 92354 200 672 20 tOO 1 87 DODGE 150 VAN 2B4HB11T HK222 33 H06 59 92354 200 672 20 -03 2 89 CHEVROLET VAN lGNEG25KOK7125010 H06 59 92354 200 672 20 LIMITATION OF USE ENDORSEMENT - FORM 13050 (8-8]) ~E AGREE ~!Trl YOU THAT THE PREMIUM CHARGED FOR THE COVERAGES SHOWN ON THE )ECLARATIONS IS BASED ON THE COMMERCIAL USE OF THE AUTO(S) DESCRIBED IN THE jOLICY AND THE AUTO(S) WILL BE CONFINED DURING THE POLICY PERIOD TO THE TERRITORY ~ITHIN THE STATED MILE RADIUS OF THE CITY OR TOWN OF PRINCIPLE GARAGING OF THE ~UTO(S). WE WILL NOT PAY FOR ANY LOSS UNDER THE POLICY WHILE THE AUTOS DESCRIBED \BOVE ARE IN COMMERCIAL USE BEYOND THE ABOVE LISTED RADIUS. THIS ENDORSEMENT )OE~ NOT APPLY TO ANY VEHICLE REGULARLY USED TO TOW OR TRANSPORT VEHICLES. LIABILITY PREMIUM BY VEHICLE /: H MED ADD NO LIAB PAY UM/BI UM/PD PIP PIP 1 :: , PHYSICAL DAMAGE PREMIUM BY VEHICLE JEH COMP OR SPEC PERILS COLLISION ON-HOOK NO TYPE DED PREM OED PREM LIMIT DED PREM 1 COMP 2 COMP 3 COMP 4 COMP $500 $500 $500 $500 $366 1366 272 270 $ 500 $500 $500 $500 $ 1 , 107 $ 1. 107 $825 $817 VEH TOTAL $ 1, 473 i 1.473 1,097 1,087 ~CANCELLATION AT INSUREDS REQUEST OR FOR NON-PAYMENT WILL RESULT IN A :ANCELLATION FEE. III $50 4.ny lOSS under Part :," Resp, File.86 IS payable as Interest dlay apoear to named Ins~red and above loss oayee: H 6 7 8 9Q,i 9Jh6rR I T 1 0 .0 C A I C S 1 llCase No Prog P'e~dgel' R/R 0, Faclor Used AT 96.71 :oun1ersIgned By /; , v.r/f,., /;' / (eX d/;. Y AuthorIzed Representative 1113 (5-77) CVPA00051788L111303 . . prog/eD7/e cOm;Janle.r led by: CALIFORNIA COMMERCIAL VEHICLE P.O. BOX 2068 RANCHO CORDOVA. CA 95741-2068 AUTO DAMAGE LIMIT OF LIABILITY POLICY CHANGE We a'gree with you to change Part III, Damage to Your Auto, as follows: LImit of Liability If the Limit of Liability shown below IS less than 90% of the actual cash value at the time of loss to your insured auto, you will share with us in the cost of repair or replacement as follows: 1. We will pay the same proportion of the loss which the Limit of Liability shown below bears to the actual cash value of your insured auto at the time of loss, 2. We will reduce the amount of loss by the Auto Damage deductible shown in the Policy Declarations prior to calcu- lating the proportionate amount we will pay. If we pay the actual cash value of the auto less the deductible. we are entitled to all salvage. No. Year Trade Name Serial No. Limits of Liability(lncluding Custom Parts & Equip.) Less Deductible Shown Below Comp/FTCAC Oed. 500 500 500 500 01 02 03 04 87 87 87 89 DODGE DODGE DODGE CHEVROL 2B4HB21T9HK220973 2B4HB21T9HK224960 2B4HB11T6HK222433 1GNEG25KOK7125010 Liability 20000 20000 20457 19197 Coil. Oed. 500 500 500 500 'II other parts of this Policy remain unchanged. Isslled to: CASTILLO & FRITZSCHE 11175 MT VIEW L LDMA LINDA CA 92354 This endorsement changes Policy No. CA 04562848-2 Endorsement Effective: 12/07/88 8470 (12-86) INSURED COpy CVPA00042588L8470 'cEASE HEM) YOUR DOLlCY -hI'" .J~CI,;H;.l~'t1ns P;HJe,Arnp.nt'l~t1 Ct~Clmall(lfl Il.1I1t' ....01:. DOLlCY "JUMBEH 0-4C;-62-848-2 )Iclc~ trfe ahovp. ntJmnl~fQo nnhcy .V 1,IC~\'t 1l1t!f1ldlt!d hv Inn torm .1nl1 edllllln 11.,IH Inflll.:a'<ld ... D'e,"ous oohev no - Fu,m 1050 Ed 0986 \** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 11/25/88 *** )E(, , A nONS \lA ..:0 INSURED CASTILLO & FRITZSCHE HEALTH LINK 11175 MT VIEW L LOMA LINDA CA 92354 Dnl'cy np.und '201 A M STANDARD TIME AT THE ADDRESS OF THE NAMED INSURED AS STATED HEREIN FROM DEC 7. 1988 TO NOV 25. 1989 PAGE 4 OF 5 CLAUS HARRY KENNEY 247 E BASELINE SAN BERNARDINO CA 92410 WL-39326 )7r17l7/2?~~~CL7n7t7i7l7i~ PROGRESSIVE CASUALTY INSURANCE CO. 6300 WiLSON MILLS RD. P.O. BOX 5070. CLEVELAND, OHIO 44101 -he Insurance al:orded IS only with respect to such and so maJ"lv 0' the fallowing coverages as are Indicated with respect to each descnbed vehicle. The limit at the ompany's liability agalnsl each suCh coveraQe snail be as staled here.n, sublect 10 all the terms of this policy having reference thereto. LOSS PAYEE :EH ZIP NO NAME ADDRESS CITY /STATE CODE 1 wE STERN FINANCL LSNG PO BOX 5937 ORANGE CA 92667 2 WESTERN FINANCL LSNG PO BOX 5937 ORANGE CA 92667 C GMAC PO BOX 50040 SAN BERNARDINO CA 92412 GMAC PO BOX 50040 SAN BERNARDINO CA 92412 LOSS PAYABLE CLAUSE - FORM 1602 (8-83) ~E AGREE WITH YOU TO CHANGE YOUR POLICY AS FOLLOWS: 1. wE WILL PAY THE LOSS PAYEE NAMED IN THE POLICY FOR LOSS TO YOUR INSURED AUTO. AS THE INTEREST OF THE LOSS PAYEE MAY APPEAR. 2. THE INSURANCE COVERS THE INTEREST OF THE LOSS PAYEE UNLESS THE LOSS RESULTS FROM FRAUDULENT ACTS OR OMiSSIONS ON YOUR PART. 3. CANCELLATION ENDS THIS AGREEMENT AS TO THE LOSS PAYEE'S INTEREST. IF WE CANCEL THE POLICY WE wiLL MAIL YOU AND THE LOSS PAYEE THE SAME ADVANCE NOTICE. 4. IF wE MAKE ANY PAYMENT TO THE LOSS PAYEE. wE WILL OBTAIN HIS RIGHTS AGAINST ANY OTHER PARTY. ~nv loss under Part I I I IS payable as Inferest may appear 10 named Insured and above loss payee: Fin. Resp_ Filed For Whom Case No: 86 H67 89019 FRIT 10.0 CAICS11C Prog P'em'um Budget: AT RiR0988%FaClor Used: 96.71 :ounterslgned By // //-1'"- ~r. ;j;;/2/vO AulhOrized Aepresentallve 1113 (5-77) CVPA00051788Ll11304 . . prolldlD7/e COm;a1fllef I~sued by: CALIFORNIA COMMERCIAL VEHICLE P.O. BOX 2068 RANCHO CORDOVA, CA 95741-2068 CUSTOM PARTS AND EQUIPMENT ENDORSEMENT Provided that you have paid any reqUired premIum, we agree with you to extend coverage under Part III. Damage to your Auto, to the custom parts and equipment listed below. Coverage under this change extends only to par1S and equipment which are permanently attached and forming part of your insured auto. The value declared below must be included in the stated amount of your insured auto for coverage. Our limit of loss will be the least of: 1, the actual cash value of the stolen or damaged property at the time of loss. or 2. the amount shown below as the Total Declared Value of EqUipment. or 3. the amount necessary to repair the property with other of like kind and quality. with deduction for depreciation. reduced by the Auto Damage Deductible shown in the Policy Declarations. No. Equipment/Parts To Be Insured Total Declared Value Of Equipment 01 WHEEL CHAIR LIFT 2500 02 WHEEL CHAIR LIFT 2500 03 WHEEL CHAIR LIFT 2275 04 WHEELCHAIR LI FT 2475 All other parts of this Policy remain unchanged. Ic;sued to: CASTILLO & FRITZSCHE 11175 MT VIEW L LOMA LINDA CA 92354 I his endorsement changes Policy No. CA 04562848-2 Endorsement Effective: 12/07/88 8471 (12-86) INSURED COpy CVPA00021088L8471 'LEASE ~EAO YOU~ POLICY -his lJtiCraralllJnS Paql:!.Amenl:l:!d OeCI.lratu;n ~iHJI' .....It, O!JLlCY "L'MBER r. 0 -4 <;-6 2 -848 - 2 I<lOttJt It1enlill~d bv Ihe fOrm ana l:!Ulllon date Int1ICi'.o-; ( ~Ies :r(e above numOf'!reu pullCY :-ECLA~A TIONS '-JM'O:O INSUREO ",evlous policy no "0, 1 050 Ed 0986 \** THIS AMENDED DECLARATION SUPERSEDES PRIOR DECLARATION PAGE EFFECTIVE 11/25/88 *** CASTILLO & FRITZSCHE PAGE 5 OF 5 HEALTH LINK IJ175MTVIEWL LOMA LINDA CA 92354 Policy penod 12.01 A M. STANDARD TIME AT THE ADDRESS OF THE NAMED INSURED AS STATED HEREIN FROM DEC 7, 1988 TO NOV 25. 1989 CLAUS HARRY KENNEY 247 E BASELINE SAN BERNARDINO CA 92410 . WL-39326 progrE'//ve companie..r PROGRESS I VE CASUALTY I NSURANCE CO. 6300 wiLSON MILLS RD, P.O. BOX 5070. CLEVELAND. OHIO 44101 18 Insurance afforded is only with respect to suCh and so many of the follOWing coverages as are Indicated wllh respect to each descnbed vehicle. The limit of the :Jmoanys liaolllty against each such coverage shall be as staled herein, SUOject 10 all the terms of Ihls pOlicy ha....lng reference Ihereto HE GARAGING ADDRESSES FOR THE LISTED VEHICLES DIFFER FROM THE INSURED ADDRESS. EH NO I 2 3 ADDRESS 11175 MT VIEW LANE 11175 MT VIEW LANE 11175 MT VIEW LANE CITY/STATE LOMA LINDA LOMA LI NDA LOMA LINDA ZIP CODE CA 92354 CA 92354 CA 92354 I lOSS under Part I I I 1$ payable as interest may acoear to named Insured ana above lOSS payee; Resp_ F,Ied- For Whom- Case No: 86 H67 89019 FRIT 10.0 CAICS11C Prog Premium Budget AT R'R0988..Factor Used: 96.71 JnterSIlJned: By A!:~ Z~//<~ Authoflzed Representative 13 \5-77) CVPA00051788LI11305 utLLAKAIIUN~ ~L~ A ~u~l~L~~ ALIG f'AI.7l:; I AMENDED 12./o1/bti PUL II.. 't NO: AS 9 01 3't 51t ITEH 1 ~htJJ t~1.I ~UUkl-S~ L.K.CA~~~FR L~Lh C.HARDcR DBA:HeALTH LI~K 11115 MT. VIEW 9L LOMA LINDA LA 9L~~1t PRODUCER CUDE: 13908 .120 , POLICY PERIOO: FROM 1l/,!t/b8 10 11/25/89 lZ:01 A.M. ~TANDARU (AT THl ADOR~5~ OF 1h~ NAM~U ~N~~R~U A~ ~TAT~U IN ThIS PULICY) INSUk~U COMPANY AND Cuuc: uo~ rNOU~lkl~~ INDEMNI1Y LA1P PkODULI::R NAMF- AND ADORE:SS KEN CLAUS INSlIRANCE' 247 cAST BASE LINE SAN Ba:RNANDINO CA 9Zlt1.0 FC03011 BROK~R: 5561t69b04 TIM E NAHEulNSlJKElJ BUSll'4c:l~: PILI\ UP IJ1ALYSlS PdlE:NT~ FOkM OF ~USINES~: PAK1N~RSHIP AUUITIONAL ~Re~lU": $Z.178 IN RETURN FUk TH[ PAY~t.Nl Uf- It'll: P~t.fo\lUi'h AI'4iJ SUB...LLl 10 ALL THt: l-t:1<1'IS OF THIS PULICY. WE Abket: WITH 'tUU lU PkUVlul:. lHI: INSUkANLI:: AS ~lAll::D IN THIs POLILY. --------------------- ITEM 2 SChELJULE Of CUVERAGeS AND CUVeRED AUTOS CSl~ ~UPFLtMtN)AkY STATE ENUUKSl::fo\l::NTS WhERE A~PLICAbL~) 1l10~~ ~N~B~ I I 1:LJ t1U L IN.JUK'r AND HuJPcRTY _ BODILY IN~URY _ PROPEkTY DAMAbl AUTO M~UILAL PAYM~NT~ IX UNINSURLD MOTOklST~ IJI::SIGNA1Eu ~TA"lI::S: CA U ~~AGt: ~Al..h xxr~~iWAx EALH AC~~~~tjl .UUO xxxxxxxxxx 30.000 xxxxx XXXXX bO.OOO I~l LIA6~T~A~~;URANI..L ~b yQVEk~P ~ESCkI~IION 7 ~PI::LH- LALL DESCTITBt:u AUTOS PEkSONAL INJURY PkOTt:L llLJN I_I AUTO MEDICAL PAYM~NT~ I~I UNINSURED f\UTuk.I$l INSu~ANL~ 7 ~~CIFILA~LY DESCRIBED AUTOS TI1I::SE Dk:CLARATIONS AAI:: l~~u~U J.N LON.J~CnON WITh ANLJ Akt: PAkT OF POLICY FORM CAOOO1(Ulb7) ILO()17tlll:IS)' APZOIOl0287) FILING: K~PORT bASIS: kE WIL~ LOMPUTE VOUK Fl~AL PREMIUM DUE WHEN We UbTEkMINE YOUk. AC1'UAL eXPUSURES. The: f::~TIHATt:LJ TUTAL PRtMlUH WILL BE CREDITED AGAINST ThE FINAL PKt:HIUM DUE AND YUU WILL BE BILLEu FOR THE BALANCE. If ANY. If THE ESTIMATED TOTAL PREMIUM EXCEEDS THE FINAL PREMIUM DUE YOU wILL GET A Rt:FUNU. 10 DETERMINE YOUR FINAL PREMIUM DUE WE MAY EXAHIN~ YOUk kECORD~ AT ANY TIME DURING,ThE PERIOD OF COVERAGE AND UP TO THKEE YEARS AFTERWARD. If THIS POLICY IS ISSUEU FOR MLRE THAN uNE YEAR! THE PREMIUM SHALL BE CUMPUTED ANNUALLY BASED ON OUR kATI::S Ok t'REHIUMS IN EFFECT AT THE BEGINNING Of EACH ,YI::.AK OF THI::. PLlLICY. ...... _~ au .tUK IlAlE i1lJN~~ ~ ,U.ST RlI\I E:t.F UAT!: PAbt:o~ .YK ~ t: ~ulu- 'tL Co IHl:>06 12701/86 .;sO.;s lf8 :081 . U~LLAKATIUN~ FUK A b~~lNL~~ AUIU t>AGl: 2 - AME.NUED lZ/07/tlt> POLll.Y NO: A~ 9 U1 :;)... ~... ----------- A VAN VAN MOLEL 15(; 791...(,0 7'71400 3 3 I' '1 3 r~~1 Ml~('I:L~ ~ lV~~~Fl F C ~ ~ 0 ul~ 0 N S B ~r~hbri~~HI~~~ EEl I NO. L 1 MIl ~ ., ~=i~U -1L~~~_ir~:~g~~I~UMP~I_____1 .1_1. ml~~kl r~l r~~F I I I J I ~ all C.~R ~All 1s~~ ~~ ~ I A~! Rtlll ~ .fA1ill n F33H07 ~ ~O 0 ...~ L ~b U~ TZ7U77~ ~ ~ 110 ':081 ./ VEHICLE DESCRIPTION 1. One (1) 1987 Dodge Van, equipped for two wheelchairs and one ambulatory passenger; 2. Two (2) 1987 Dodge Vans, equipped for two wheelchairs and four ambulatory passengers; 3. One (1) 1989 Chevy Van, equipped for two wheelchairs and four ambulatory passengers; 4. One (1) 1990 Ford Van, equipped for two wheelchairs and four ambulatory passengers (*TO be delivered the beginning of December, 1989). Total vehicles in operation for non-emergency transportation: 5 U C,", LA"" I .&.urw.,) rul'\ '" CU.,); J....Co..,);.. AU I U I""ur;:; ,;) AMENDED 12./07/88 POLiCY NO: AS 9 01 34 54 1--" 3 SCHEDULE OF COVERE D AUTOS ______l..__--.-.;... L L r~~1 U.-Lb L~ ~ to tL.LC L l:: } N t (j .B M15C<LlAiiEDT.:.~::..J "!>W"N S _ ~._--L__l_ ~j ~~~ll !~l ~~r tt] ... l 1 A b 1 L 1 1 Y L 1 HI' S U "IUN'Gt - I INSUkt:l.J 1_ I4!lIDk 1ST ~ LL PAY Fl ~~:1:U D~~~~:~~~UM~l-I----I---J-~~ -1~1 ~MI IIMS r~l' E IpfhtrNLL I I I j. I I I 0004:bARAGING CHANGc;ADDITIuNAL ~AR; IU Ie I::l ~ LU R 0 ~ n: X.JI1l S t-I:J .tb4,I. LA ~:r lot lJ\I .l::l::E.J.lAI. ~.I:.S. Xli F~~a07 --E-- b90Io ..2 ~ ob~Ub T271f77lf6 ~ lib IlD :081 / INDEX Subiect Letter from Clara Hangan Letter from Tom Egan, President of California Medical Transportation Letter from Dr. E. R. Serros, Nephrology & Internal Medicine, San Bernardino Letter from Dr. George M. Grames, Nephrologist, LLUMC Current Certificate of Insurance Current Financial Statement Prescription for non-emergency transportation Title 22 Pre-set charges in regards to non- emergency transportation Paqe Number 1 2 3 3a 4 S 8 10 IS ~ <s"\. CMTA ... ! California Medical Transportation Association, Inc. January 3, 1990 To ..-horn it may concern: The California Medical Transportation Association (CMTA) is a body which represents primarily nonemergency medical transportation providers throughout the state of California. The ~ITA is interested in promoting the highest level of care and professionalism among its membership and, in fact, within the industry at large. Nonemergency transportation services are usually rendered to those whose chronic illness has exhausted their financial resources and caused them to be Medi-Cal (California's Medicaid program) beneficiaries. These services are then regulated by Title XXII, California Regulatory Code. Nearly all of these services require prior authorization by the Medi-Cal program so utilization is severely controlled. With this in mind, the only determination of choice (for the user) is the level of service. Without competition, there can be no alternative and hence, no reason to maintain optimum service levels. The CMTA will not and can not take a position for or in opposition to its membership, or any provider of nonemergency medical transportation. The CMTA will, however, point out that the free enterprise system is based on competition for cost, quality and survival. While emergency ambulance service might need some restraints due to the urgent nature of that service and, thus, limit the ability of clients to "shop" for an appropriate or alternative service (it is hard to make an objective choice when one is experiencing chest pains!). Nonemergency medical transportation, on the other hand, does not need the same restraints because there is al..ays time and usually a long term relationship in which to make a comparison. The CMTA stands for the free enterprise system wherein the costumer makes a decision based on price and quality of service and the better providers of service prevail. ~relY Yo~ r=4P Executive Director fF::an g~ ? ~/ President P.O. Box 296 . San Bruno. California 94066 · (415) 877-8250 .3 EDWARD R. SERROS, M.D., F.A.C.P. NEPHROlOGY AND IN1CRNAL MEDICINE 489 EAST 21ST S1llEf:T" SAN BERNARDINO. CAILFORNIA 9H04 -~ 'i -~ -' (714) 882.0702 J~~'la::-"! 4, 1990 ~!~. Gary ~~!~=:te R~-2.l :~-"S~~~ : : ~ 7 ~ ~ ~ ~. ".1':' e :.;. =''': .:.- ~ -= !.. ~, -~ :- ~ =- 2. :-: ~~~., r: ~4.. 9:?: ~ . ~..::...:: : - ':"' ~.... .... .- -':' - - ........ ~ .... : ~.:~ :!~~-!~~S ?~~~~~:s ~-::.... _..~"",--.'-' --- - 11==.::-=-- ,.... ~ =- ~ - -- "= ~ <::: --'- --- C.;!:'":E:- :-=-::~ ".of....... 'C"_:..... - -...... - . ':' ~-; :. s l = ~ '": ~':...- ~::2~~J-~~; ~.~ ~he c~~versa~~0~ ~;~ ~~~ .~ :~:~~bs~. :~~? .- ~S,~2~~ ~c ~ra~5;c~tatio~ s€rvi=es a~ ~~9 s~~ B~~~3r~~~J V3!~SY rialys~5 Cen~e~. As you w~l: k~Gw, ~~r~ A~~'~l~t~~ p~G'.'~~ES for t~e ~~ans~'c~tation of ~y pa~ie~~s 3'": t~e s~~ EEr~~~~~~~ V~lley ~!alysis Ce~ter. I~ my ~~~d tte ~~j':r pr~tl~~ ~~~t~ '":~s C~~e A~t~lette se~vice is th~~ SG~~ ~~~i~~~s :JCC83~~~~1:~ a~e not ~rea:ed i~ a cou=teous ~a~~E~. ~ ~?~S ~2~~~~~ ~~ r~y~i~ally rn~shandled b~~ fc~t~nat~ly ~his ~s ~~~ ~~~~~~~:~~: ~n dlscuss~~q t~ans~o~ta~i~~ prc~l;~s ',:':' "::~ ":~.~ :-:7a:: !~'_:~':~ -==, : ::2 l-=~ "::::, 1:.:-.:1C 1 'lde 'tr:e.. t ~-e':-= ~..l: 1 :.~ WE !-.~':.r-= ~~:=': :--!~d :::~::::'.:1:i-=3 2.:: b::.-I5.:i'J th~ V3.:; se:-?i.:"-= 1::-::::;;- :~~ ~:~~~S~~S ~~ ~~~ ~~:~0D~i~~~ ~:~~~ a~d taki~; t~~~ ~~~S ;~':':T.; -:: 1 y. ! s'lspec: chat th~ dialysis unit patients will t2 best provided by a cha!ce between two medical transportation se::-vices since the competition will likely improve t~e se~vice and theoretically should decrease the cost. I~ I c~n answer any furthe~ questions for you, please call .......::. Si.:-..:8!'-ely. >>~~ Edward P. Serros, M.D"F.A.C.P. ERS/mg LOMA LINDA PHY v,--=IANS MEDICAL GROU~, iNC. '" ~ j"'" POBOX 905 . SUITE 3J50. 11370 NJDERSON smEET LOMA LINDA. CALIFORNIA 9235J 714/796,4840 825 1600 Alle1a.- N" dRQn COlcj.)kXJy 70", .1A..l.1 ()cffTY)I'"'llQ()" n",\.~~ rr~ Icx:f1rY"ll'~:u 7"', .1fU~ C'7'lS1rl)("Qt<:.>.ry(Y)'; 7~:, .1~~O r::renPfol "'1~lr!~ n" .18~O In'ec~()JS Deseose 7Q6.d87Q ~0l0g{ .8211 052' Nf:!oo.IOiOav ]/)" rfMO Ox:ol('Q..l ~Idct]y 7'Jf,.,IP.,q..., P\jtT'()l"'OrY 701-. A8Q.~ ~P\J'T'lO'oIOCl'1 70~.18.,";() Jdnuary 8, 1990 Le:a Ga<,lnon ?urea\! ,f Franchi5es city of San Bernardino 30n N. "D" street San Bernardino, CA ~2110 Dear Mr. Gagnon and Committee Member~: ~hi~ letter is to support the application of Health-Link to provide ~on-emergency medical transportation service for the City of San Bernardino. Bp.ing a Nephrologist at Lorna Linda University Medical Center I have a number of patients who receive maintenance hemodialysis at Loma Linda and live within the City of San Bernardino. Health-Link is a non- emergency medical transportation service that has provided transporta- tion for our patients since 1986. During this period of time Health- Link has proven to be well organized, dependable, and efficient. On repeated occasions Health-Link has rapidly adapted to the sudden changes in patient scheduling and the need for urgent transportation to the University Medical Center necessitated by unexpected medical complications. If Ho.alth-Link were permitted to operate within the City of San Bernardino, not only my patients, but also the City of San Bernardino would be better served. Sincere:ly, /~L,~ <?'<-~ Sporge M. Grames, M.D. ~ephrologist, LLUMC ~ "......../ THE EMPIRE INSURANCE COMPA -::S 1 EXECUTIVE OFFICES: 1624 DOUGLAS STREET I OMAHA, NEBRASKA 68102 CERTIFICATE OF INSURANCE This is to Certify. that policies ill th~ nom., of I "I THIS CERTIFICA TE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS. EXTENDS OR ALTERS THE COVER^GE AFFORDED BY ANY POLICY DESCRIBED HEREIN. , NAMED INSURED ..... ADDRESS L Careo Enterpises DBA: HfALTH LmK 11175 Mt. View, Suite #L Lama Linda, California 92354 ~ are. in force at th" date hereof. as follow' KINO OF 1---- !.UO..L~I.CEY" _._n._ INSURANCE 1 '" <Y< 'l-_u I , POLICY PERIOD LIMITS OF LIABILITY GENERAL LIABILITY BOOIL Y INJURY PROPERTY DAMAGE J ~, ;c Ie "I & C L...r.."t.. E" S S S .000 E-JCh OCCUrrp.nce S .000 Agyreyate S is .000 Each Occurrence ,000 Aggregate .~_ !lr -:- _'Go",,,. E.o ....: I"I"~'..: lull l '..O,I'~\I PI ('I,h...: .. ". ,,";)1 :LJ~"!'"'' ! , '" S .000 E~'ch Claim PROFESSIONAL LIABILITY I , l-- Eop S ,000 Aggregate I i DEDUCTIBLE I \ CARGO Ell . o Sloo o S250 OSlOoo Os Truckmen Legal Liability E.p SUBJECT TO SEPARATE LIMITS OF LIABILITY FOR eACH VEHICLE . AS SPECIFIED IN SCHEDULE BELOV'll ,-- AUTOMOBI LE L1ABI L1TY . HODIL Y INJURY PROPERTY DAMAGE ~vwned AiJlomobll., CL 50 55 92 Ell 11/30/89 $ .000 Each Person $ ,000 Each Occurrencel 0 11/30/90 $ .000 Each Occurrence! Accident Compr."."'''''. AutOtnohl'. Exp ACCIdent 0 H.,.d AutomObile eODIL Y INJURY AND PROPERTY DAMAGE Q Non.Qvwn.o Al,Jtomobll. COMBINED SINGLE LIMIT 0 Conllftge"t Ll.bllotv INon.Trucklnq UNl S 1,000 .000 Each Occurrence! ACCident .- 0 COLLISION * 0 SPECIFIED * 0 FIRE, THEFT. * PERILS CAC I CL 50 55 92 Eft, 11/30/89 0 S 250 Deductible o $2S0 D~tible 0 $250 Deductibfe AUTOMOBILE E.p. 11/30/90 0 S 500 Deductible Q{ $1000. OED. PHYSICAL DAMAGE XX $1000 DMtuctlble 0 $100 O~etibl. 0 S100 Deductible . * SUBJECT TO STATED VALUES ON SCHEDULE BELOW. I ---l --. .:',.. l."'~"" ... c.....,.. 1 "I >- ---J s ,(100 E.1Ch Occu r r~nc.. 1:'= s .000 Aggregate Schedule of Automobiles or Classifications .'. .' In the event of any mate"al change In. or cancellation of, said policies. the undersigned company will endeavor to give 10 days wr;tter notice to the rarty to whom thiS certlf,catP 's 'ssued, but failur~ to give such notIce shall impose no obligation nor liability upon the company D~lrd December 26, 1989 Check Name of Company' o Empire Fire and Marine Insurance Compan, or . Insurance Com;:lany I CITY OF SAN BERNARDlliO "I O#,,,t.l FI.C. .tIA./NC EMnltC INDUI/l/rrr CERTIFICATE ISSUED TO: NAME .M ADDRESS L -.J EM 15 05 104-82) s DONALD L AOGE=lS. CPA RrCHARD 0 ANO~~SON, CPA' DENNIS H, MALOC( II. CPA .,JACK C SCOTT. C;:lA. JAY H ZERCHE~ CPA WILLIAM E REIN:::":ING. CPA ROBERT E3 MEMC>:lY. CPA THOMAS V HESS CPA "ACCOUNTANcY CORPORATION ROGERS, ANDERSON, MAWDY & Scarr CERTIFIED PUBLIC :-'CCOUNTANTS A PARTNERSHIP INCLUOING PROFESSIONAL CORPORATIONS VANIR TOWER SU'TE 300 290 NORTH :-0"" STREET SAN BERNARDINO. C"L1FORN'A 92401 Mt: MI3ERS (714) 889.0071 (714) 824.6736 FAX (714) 889.5361 AMERICAN INSTITUTE OF CERTIFIED PUOuC ACCOUNTANTS PRIVATE COMPANIES PRACTICE SECTION OF fHE DIVISION t=QR CPA FIRMS GARY L SILVIUS CPA MARILYN J. SELlF0RS CPA TERRY P SHEA., C:I..1, ALBERTA M HESS CPA NANcY O'RAFFEF=l":"V CPA JOSEPH W WILEy CPA SANDRA M McNE:.... CPA CALIFORNIA SOCIETY OF CEf-iiIFrEO PUBI:C ACCOUtl rANTS December 18, 1989 Careo Enterprises, Inc. Dba Health-Link 11175 Mountain View, Suite L Loma Linda, California 92354 We have compiled the accompanying statement of assets, liabilities and stockholders' equity arising from cash transactions of Careo Enterprises, Inc., dba Health-Link, as of September 30, 1989 and the related statement of revenues and expenses for the three months then ended, in accordance with standards established by the American Institute of Certified Public Accountants. A compilation is limited to presenting in the form of financial statements information that is the representation of management. We have not audited or reviewed the accompanying financial statements and, accordingly, do not express an opinion or any other form of assurance on them. The company's policy is to prepare its financial statements on the cas~ method of accounting; consequently, certain revenues and the related assets are recogn i zed when rece i ved rather than when earned, and certa in expenses are recognized when paid rather than when the obligation is incurred. Accordingly, the accompanying financial statements are not intended to present financial position and results of operations in accordance with generally accepted accounting principles. Management has elected to omit substantially all of the disclosures required by generally accepted accounting principles. If the omitted disclosures were included in the financial statements, they might influence the user's conclusions about the company's financial position and results of operations. Accordingly, these financial statements are not designed for those who are not informed about such matters. ROGERS, ANDERSON, MALODY & SCOTT ~~u~~.:t~~ .' CAREO ENTERPRISES, INC. DBA HEALTH-LINK STATEMENT OF ASSETS. LIABILITIES AND STOCKHOLDERS' EOUITY SEPTEMBER 30. 1989 ASSETS CURRENT ASSETS: Petty cash Cash in checking Cash in savings Prepaid taxes Total Current Assets FIXED ASSETS: Furniture and fixtures Machinery and equipment Vehicles Less: Accumulated depreciation OTHER ASSETS: Organization costs (net of accumulated amortization) Deposits TOTAL ASSETS LIABILITIES AND STOCKHOLDERS' EOUITY CURRENT LIABILITIES: Payroll taxes payable Contracts payable - amount due within one year Total Current Liabilities OTHER LIABILITIES: Contracts payable - amount due after one year TOTAL LIABILITIES STOCKHOLDERS' EQUITY: Capital stock - 300 shares issued and outstanding Retained earnings, beginning of year Excess revenues over expenses Less: cost of 100 shares of treasury stock TOTAL STOCKHOLDERS' EQUITY TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY See accompanying accountants' compilation report. , $ 103 10,933 10,595 1.477 23 . 108 6,739 15,457 37.433 59,629 ( 25.869) 33.760 379 6.403 6.782 $ 63.650 $ 1,862 5.626 7,488 18.025 25.513 7,500 20,783 12,354 ( 2.500) 38 . 13 7 $ 63.650 CAR EO ENTERPRISES, INC. DBA HEALTH-LINK STATEMENT OF REVENUES AND EXPENSES FOR THE THREE MONTHS ENDED SEPTEMBER 30. 1989 REVENUES: Medical transport fees Interest Total Revenues EXPENSES: Advertising Amortization Bank charges Depreciation Dues and subscriptions Equipment rental Insurance Interest Legal and accounting Licenses Offi ce expense Officers' salaries Payroll taxes Rent Uniforms and laundry Utilities and telephone Van expense Wages Total Expenses EXCESS REVENUES OVER EXPENSES BEFORE INCOME TAXES INCOME TAX EXPENSE: Federa 1 State Total Income Tax Expense EXCESS REVENUES OVER EXPENSES See accompanying accountants' compilation report. 1 $ 70,205 125 70.330 1,206 42 47 3,336 311 2,652 3,140 781 3,173 277 1,553 7,000 4,143 1,758 74 977 4,808 22.698 57.976 12.354 $ 12.354 nL.nJ..,l.44 - _.....~ 11175 Ht. View suite T. Loma Linda, Ca. 923 714 370-0962 ~ :.r PRESCRIPTION FOR NON-EMERGENCY TRANSPORTATION PATIENT NAME: (' / E Vw Il)rJd :JOIJlV 5 ON WHAT PHYSICAL DISABILITY PREVENTS THIS PERSON FROM RIDING IN A PRIVATE AUTCMOBILE OR PUBLIC CONVEYENCt? ~ ~ r~O>1~~ (JA'J , WHAT ASSISTIVE DEVISES DOES PATIENT USE, IF ANY? ~;I~~ I -,l(-Y'AGNOSlS' ~~~~ L),A'~, ~ ~ ~~_ ~~4--- FROM @SNF): dL/-S- E. /<,1 st.. j?J".4/to] CI1 QJ3?w TO @SPlT.9 DRS. O~rjCC:. ETC.): L~vrnC - (J/,4~/~ D.';TE OF THIS TRIP: })tc die, I 19'~ +0 .TAN 023. /910 PU~POSE OF ~ VI SI T (X-R.:"YS ,ETC (t, (.~(~ IIEmO dtAr-S/5 3 X wt NEXT APPOINTMENT DATE: TIME: 4 IF MULTIPLE TRIPS FREQUENCY: 3 X tJk J:6K / mONJh DURATION: FOR PuRPOSE OF: IIErnOcYA/'l/:S/5 . J .1~~ 'i, /710~Tn * "* PHYSICIAN'S SIGNATURE: ., CALIFORNIA LICENSE ~~~ ~j~~ 6 (;? jrz.- DATE: /2/ z o/d'5'" -, "* piYSICIAN'S NAME A.NUU~ (~~~~) S. T ~l en \ryj CL!\ II L ~ 4- N\eJ-0- rScJ f\:J S-n-ee.. -t 10 m 0L U l~ ([4., I C JJ. (1'23 7. ~ P lea.~ ~L.;-+e L<C'i,bly cv Lo......plete 1'1 '. I. tl-l<..J FI'/I 1t A~I\+'CN : . 'W') .~ ~~ {7 ~ ,," .IJ+'O ~~ C 1/3../Et'-"" flUe/ JOIvvSIJV1...J $ ~ I K',/ f+l, rv1fJ 1kvJ5 L~, ,~J:tJ . !!,,;JO-~7tJ9 ~ .:"-': c';;'::' -<, -:. ::' _, -,-. I.~,O.::' .., G' .~ --' --" ~ ,'./,' ...' ..( 30-c7D-'1- 5-~--=~ :{..J-5 - ~'<:(8'- Q- (- ") .. , <, ;, ___I):~. __ (A! ~ r I, C'~'.~ Oz, 5t-{c..:'IZ Li~ , \'1 /' >r.r-. -:J.- ~./ '1,1 ~- - '. . C.J-(,:"> ~, I~ t - ~ I. "S' /-',J -. 7/ g'C) :>' L 4140 I C-ri 0.)-"'// ,Ie ..:> / \,.,."":' {j-.;?~>2 ~v fl1 ;':i /', ~I r. 10 [-f."UtVJe. -- i!c5r D ~/ysls .5< WI:: /-)I~bEh'c. _:)Oc I 'os h(J5 1/1~h - , rY} 5u.fP, / c:~" .S~-;I_-_'/:::/_-'. /;7 J'V11 . , /!. . Q!!!I' NEled copy" +- ))l'/'fpny m .(' PJec.. tYI/c"}/ '-..- /" ./~~ l7 ~ ,'" . I' " TITLE 22 MEDICAL ASSISTANCE PROGRAM ~ 51152 (p. 1262.5) I Ravtatar 11. No. 27-7~1 51151.3. Litter Van. "Litter van" means a vehicle which is modified, equipped and used for the purpose of providing non emergency medical transportation for those patients with stable medical.conditions who require the use of a litter or gurney and which is not routinely equipped with the medical equipment or personnel required for the specialized care provided in an ambulance. :-iOTE: Authority cited: Sections 14105 and 14124,5, Welfare and Institutions Code. Refer- ence: Section 141:12. Welfare and InstitlltiOolS Code. HISTORY: 1. Npw section f'ilcd 5.~-Sn; ('rfl...~.tin" thirlit.'th day thereafter (Re~ist~r BO. :'\0.21). 51151.4. Liller Vlln Patient. "Litter van patient" means a patient whose medical condition is sllch that the patient may be transported by a litter van, "OTE: '\lIthoritv cited: SectlOll> 14105 and 14124.5. Welfare and Institutions Code, Refer. l"nce: St'Ctioll 14'1:12. \\'(.Ibr(' :mci Institutions Cone. HISTORY: 1. New scction fll,'C\ 5.2;:-80; cffecti". thirtieth day' thereafter (Register 80, ~o. 21). 51151.5. Wheelchair Van. "Wheelchair \an" means a vehicle which is modified, equipped and used for the purpose of providing nonemergency medical transportation for wheelchair van patients and which is not routinely equipped with the medical equipment or personnel required for the specialized care provided in an ambulance. NOTE: Authority cited: Sections 1410.5 and 14124,5. Welfare and Institutions Code. Refer- ence: Section 14132. Welfare and Institutions Code. HISTORY: 1. New section filed 5-22-80: effective thirtieth day thereafter (Register SO, No. 21), 51151.6. Wheelchair Van Patient. NOTE: Authority cited: Sections 1410.5 and 14124.5. Welfare and Institutions Code. Refer- ence: Section 14132. Welfare and Institutions Code. HISTORY: 1. New section liIe'! 5-22-80; effective thirtieth day thereafter (Register SO. No.21), 2. Repealer filed 6-22-87; operative 7-2:1.~ (Register 87, No. Z7). 51151.7. Noncmergenc)' Medical Transportation. "Nonemergency medical transportation" means transportation by ambu- lance, litter van and wheelchair van of the sick, injured, invalid. convalescent, infirm or othemise incapacitated persons whose medical conditions require medical transportation services but do not require emergency services or equipment during transport. NOTE: Authority cited: Sections 14105 and 14124.5. Welfare and Institutions Code, Refer' ence: Section 14132, Welfare and Institutions Code. HISTORY: 1. New section filed 5,22.SO; effecti,'e thirtieth day thereafter (Register SO, :-10.21). 51152. Provider of Medical Transportation. "Provider of medical transportation" means an individual or organization furnishing medical transportation services as defined in Section 51151. NOTE: Authority cited: Sections 10725. 14105 and 14124,5, Welfare and Institutions Code, Reference: Section 14132. Welfare and Institutions Code. HISTORY: J. New section filed 1.30-73: effective thirtieth day thereafter (Register 73. No.5). 2. Change without regulatory effect adding NOTE (Register 86. No. 49). I I \ ~ 51323 (p. 12741>\ (G) Scissors. forceps, and nail files, (H) Weighing scales. (I) Ice bags. m Flashlights.. (K) All equipment otht'r than masks. nasal catheters and positive pressure apparatus necessary for the administration of oxygen. (L) Other equipment commonly used in providing skilled nursing facility services or intprmcdiatc care services. NOTE, AlIlh{)nl~' cited, Section, 14105 and 14124.5. Welfare and Institutions Code: and Section 571c\. rhaplcr J2~. Statllt"s of 19R2, Referene", Sections 14053. 14132. 14133. 14133.1 (el alld 1413:13. \\\.Ifan' ;Ind Institutions Codt..... HISTORY, I. ArneIHj,IH'llt or ,,,h,,'ctl<lllS (I,) and (1'\ filcd 11-4-76: effcctive thirtieth day lh",,,af- ler (Heg;str'r 7h. :\0.45). For prillr hi'lory, ,ce ficgi'lcr 72. No. 31. 2. Amendm{'nl of subsection (h) filed 5-2.5-TI; effective thirtieth day thereafter (Regis- ter 77, No. 2,2) 3. Amcndmclll or slIbs{'ction I hi filed 8-8-78; effective thirtieth day thereafter (Re~is- ter 78. No, 32). 4. Amcndm{'nl or sub,ccllon la) filed 9-I-R2 as an emergency; dfecti\e upon filing (Register 82. :\0 31, A Cerlif,catc of Compliance must be transmitted to OAL within 120 days or emergenc\' 1.",?ua?e will b" rcpealed on 12-30-82, 5. Certiflcat" or eOlllpl,.lIlce tr.lI"lTIitt"d 10 O.\L 12-2B-R2 and filed 1-21-8.1 (R{'~i'h'r 83. :\0.41. 6. AmendmeJlt ll! \UbSt'C!HH1::i rbJ .md (e) filed 11-7.86; effective thirtieth da~' thereaf. ter (Rel1;ister ~Ii. '0 -151 7. Changc \\;lholll r~~lIIJtor\' ,.rfcct of "aTE (Register 86. No.49). 51323. Medical Transportation Services. (a) Ambulance. huer van and wheelchair van medical transportation serv- ices are covered \\ hen the beneficiary's medical and physical condition is such that transport by ordinary means of public or private conveyance is medically contraindicated, and transportation is required for the purpose of obtaining needed medical care. (1) Ambulance sen'ices are covered when the patient's medical condition contraindicates the use of other forms of medical transportation. (2) Litter van scn'ices are covered when the patient's medical and physical condition; (A) Requires that the patient be transported in a prone or supine position, because the patien t is incapable of sitting for the period of time needed to transport. (B) Requires specialized safety equipment over and above that normally available in passenger cars. taxicabs or other forms of publie conveyance. (el Does not require the specialized services. equipment and personnel provided in an ambulance because the patient is in stable condition and does not need constant observation. (3) Wheelchair van servIces are covered when the patient's medical and physical condition' (A) Renders the patient incapable of sitting in a private vehicle. taxi or other form of public transportation for the period of time needed to transport. (B) Requires th;;t the patient be transported in a wheelchair or assisted to and from residt'nce. vehicle and place of treatment because of a disabling physical or mcntallimitation. MEDICAL ASSISTANCE PROGRAM TITLE 22 (Reolater 16. No. 49-12.... I?- ....,.. TITLE 22 MEDICAL ASSISTANCE PROGRAM ~ 51323 (p. 1274.7) (Regilt., lII. No. 8-2-2fl.a1 (C) Requires specialized safety equipment over and :lbove that normally available in passanger cars, taxicabs or other forms of public conveyance. (D) Does not require the specialized services, equipment and personnel provided in an ambulance, because the patient is in stable condition and does not need constant observation. (b) Authorization shall be granted or Medi-Cal reimbursement shall be ap- proved only for the lowest cost type of medical transportation that is adequate for thc patil'nt's mcdical needs. and is available at the time transportation is requITed. (I) Emergency medical transportation is covered, without prior authoriza- tion, to the nearest facility capable of meeting the medical needs of the patient. Each claim for program reimbursement of emergency medical transportation shall be accompanied by a written statement which will support a finding that an emergency eXISted, ~otwithstanding Section 51056 (b), the statement may be made by the provider of the emergency transportation, describing the circumstances necessitating the emergency service. The statement shall in- clude the name of the person or agency requesting the service, the nature and time of the emergency. the facility to which the patient was transported, rele- vant clinical information about the patient's condition, why the emergency services rendered were considered to be immediately necessary and the name of the physician accepting responsibility for the patient at the facility. (2) All non emergency medical transportation, necessary to obtain program covered services. requires a physician's, dentist's or podiatrist's prescription and prior authorizatIOn ocept as provided in (C). (A) When the service needed is of such an urgent nature that written au- thorization could not have reasonably been submitted beforehand, the medical transportation prOVider may request prior authorization by telephone. Such telephone authnnzation shall be valid only if confirmed by a written request for authorization (B) Transport,ltlOn shall be authorized only to the nearest facility capable of meeting the patIent's medical needs. (C) l\onemen:enc\' transportation services are exempt from prior authori- zation only when prOVided to a patient being transferred from an acute care hospital immediatel\' following a stay as an inpatient at the acute level of care to a skilled nursmg facility or an intermedjate_c;,are fll~ili!y_licensed pursuant to Section 1250 of the Health and Safety Coae. (c) Medical trJnsportation by air is covered under the following conditions: (I) For emergencies, only when such transportation is medically necessary as demonstrated by compliance with paragraph (b) (1) and either of the follow- ing apply: (A) The medIcal condition of the patient precludes other means of medical transportation as indicated in the statement submitted in accordance with paragraph (b) (1). (B) The patient or the nearest hospital capable of meeting the medical needs of the patient is inaccessible to ground medical transportation, as indicat- ed in the statement submitted in accordance with paragraph (b) (I). ,3 ~ .'512:31.2 (I', 1264.4) \IEDICAL ."SSISTA:\CE PROGRAM TITLE 22 (Register 86. No. .~12-&.86J \ (2\ Standard brake and light certificate issued by the Department of Con- sumer Affairs within 4.) days following the annual renewal date, i'OOTE: Authnrity cited: Sc'ctions 1410'; and 14124,5, Welfare and Institutions Code, Refer- ence: Section 141:32, Welfare and Institutions Code. HISTOHY: L :\ew section filed 5-22-1lO; effective thirtieth day thereafter (Register 80. No,21), 51231.2, Wheelchair Van Requirements. (a) Wheelchair vam shall be operated by a certified driver and, where appli- cable, an attendan t. (1 l These persons shall: (A) Possess a currentl.alifornia driver license or a current California Ambu- lance Dri\'er Certificate issued by the State Department of Motor Vehicles. (El Be at least 18 years of age. (Cl Possess at least a current American Red Cross Standard First Aid and Personal Safety Certificate or equivalent. (D) Have passed a physical examination within the past two years and pos- sess a current Department of ~Iotor Vehicle form DL-5I, Medical Examination Report, which is specifically incorporated herein by reference. (E) Not act in the capacity of a driver or attendant when such person: L [s required by law to register as a sex offender for any offense involving force, duress, threat or intimidation. 2. Habitually or excessi\'ely uses or is addicted to narcotics or dangerous drugs, or has been com'icted during the preceding seven years of any felony offense relating to the use, sale, possession or transportation of narcotics, addic- tive or dangerous drugs or alcohoL 3, Habitually or excessivelv uses intoxicating beverages. (b) Wheelchair vans shall be equipped with at least the following; (1) One standard-sized wheelchair. (2) Loading entrance large enough to accommodate a patient comfortably seated in a standard-sized wheelchair. ~ (3) Emergencv exit, other than loading entrance, that can accommodate a standard-sized wheelchair. (4) Locking devices for all doors and all door latches which shall be operable from imide and outside on all vehicles manufactured and first registered after January 1, 1980. (5) Seating capacity to accommodate at least two patients seated in stand- ard-sized wh€'elchairs. (6) Approved scat belt assemblies for the driver and any front seat passen- gers. (7) Fasteners to secure the wheelchair to the vehicle which must be of sl!fficient strength to prevent the chairs from rotating, to prevent the chair wheels from leaving the floor in case of sudden movement and to support the chairs and patients in the event the vehicle is overturned. (8) Lift or ramp with a load capacity of at least 450 pounds which can be secured to the vehicle, (9) Foot stool or extra step for loading. (10) One interior light. (11) Portable, battery-operated light. (12) Controlled heating and air conditioning system in the patient compart- ment. 03) Seats covered with washable vinyl, or similar impermeable material which shall be in sanitary and functional condition. 1"1 TITLE 22 MEl)lCAL ASSISTANCE PROGRAM ~ 51234 (p. 1264.5) (Regia'., 88. No, &-2.2_1 (14) Spare wheel,jack and tire tools necessary to make minor repairs except when operating where ~ervice and repair cars are immediately available. (15) Current maps of the streets in the area where service is provided. (16) Fire extinguisher, type 4-B:C dry powder or carbon dioxide. Vaporizing liquid extinguishers shall not be used. (17) Identification display of the name under which the wheelchair van is doing business or providing service, on both sides and rear of each wheelchair van in letters that contrast sharply with the background. Lettering for upper case letters shall be not less than four inches in height, or proportionate width, and of color readily visible during daylight. Lower case letters shall be no less than three.fourths of the upper case height. All wheelchair vans operated under a single license shall display the same identification. (c) Wheelchair van providers shall be licensed, operated and equipped in accordance Ivith applicable federal. state and local statutes, ordinances and regulations. (d) Wheelchair van providers in other states shall comply with applicable federal, state and local statutes. ordinances and regulations. (e) All wheelchair passengers Inust be secured to wheelchairs while being loaded, unloaoed or transported. (t) Neither orin'r uor atteno'lIlt shall smoke in the wheelchair van, (g) Wheeichair vall providers shall furnish the following information to the local ~ledi.Cal Field Office all an annual basis: (1) Statement of huurs and geographic area served. (2) Standard brake and light certificate issued by the Department of Con- sumer Affairs within 45 davs following the annual renewal date, :-';OTE: Authoritv cite& SectIOns 14105 and 14124..5. Welfare and Institutions Code, Refer. ence: Section 14'132. Welfare and Institutions Code. HISTORY: I. :'\ew section filed 5,22,80; effective thirtieth day thereafter (Register 80. l"o. 21 \. 51232. Psychologist. A psychologist shall be licensed by the Psychology Examining Committee of the State Board of ~Iedical Quality Assurance or be similarly licensed by a comparable agency in the State in which he practices. NOTE: Authoritv cited. SectIons 1072.5. 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14059 and 14 132. Welfare and Institutions Code. HISTORY: I. Amendment filed I; -4,76; effective thirtieth day thereafter (Register 76, :\0.45). 2, Change without regulatory effect adding ~OTE (Register 86, No. 49). 51233, Optometrist. An optometrist shall be licensed by the California Board of Optometry to practice optometry. or be similarl~'licensed by a comparable agency of the state in which he practices. NOTE: Authority cited: SectIons 14105 and 14124.5. Welfare and Institutions Code. Refer- ence: Sections 14131 and 14132, Welfare and Institutions Code, HISTORY: I. Change without regulatory effect adding :-IOTE (Register 86, :-10.49). 51234, Psychiatric Technician. HISTORY: '1. :'\ew section filed 1-30-73; effecti\'e thirtieth day thereafter (Register 73. ;\0. 5). 2. Repealer filed 6-22,8;; 6perallve ;-22-87 (Register 87. :'\0.27). Program Coverage (Section S1323) Label Requirements ,5' medical transportation o Ambulance and other medical transpor tation is covered only when use of ordinary means of public or private conveyance is medically contraindi- cated and transportation is required for the purpose of obtaining needed medical care o Emergency transportation is covered tJ the nearest facility capable of meet- ing the patient's medical needs o Non-emergency medical transportation necessary to obtain medical services is covered subject to the written pre- scription of a physician, dentist or podiatrist o , ,... Emergency medical transportation by air to the nearest hospital capaGle of meeting the patient's needs ii covere3 subject to the following additional stipulations: The medical condition of the patient precludes other means of transportation, or The patient or the nearest hospital meeting the basic criterion is inaccessible to ground medical transportation o Non-emergency medical transportation by air also may be covered when nec- essary due to the patient's medical conditions or when practical consider- ations make ground transportation unfeasible. The medical necessity fo: such transportation must be substan- tiated by the written order of a physician, podiatrist or dentist. o POE label valid for the month of serv k-= A-12 Allied Health 114 Reprinted June 198' " , t.. " . special Billing Instructions (Continued) o Medical transportation by air must be billed "By Report." The claim must include an itemization of services. Included in this section (Figure A-2) is a suggested itemized statement form. Providers may develop their own format, but it must include all ele- ments on the suggested form. This form does not preclude the requirement for an emergency statement or prior authorization. Air transportation claims without required documentation will be den i ed . o When transporting transfer patients from an acute inpatient hospital to a skilled nursing facility or intermedi- ate care facility, the patient must already be discharged from the acute facility and ready for transport. Medi-Cal does not cover waiting time or night calls for this type of trans- por t. Payment (Section SlS27) o Separate reimbursement will not be made for services or items included i1 the base rate such as: Backboards Flat/scoop stretchers Long boards Disposable oxygen masks and tubing Disposable IV tubing Childbirth assistance Restraint of patient Suction/suction equipment Resuscitation Respirator/IPPB A crew of two pickup off paved road Pickup of overweight/hard to get at patients Linens and blankets o Reimbursement will be made based on the provider's charge to the general public, not to exceed the maximums shown below: Code Number Maximum Allowanc ~ Description Ambulance Transportation Response to Call: 0001 1 patient 0002 2 patients, each patient $ 61. 71 37".02 A-14 Allied Hea\th 111 Revised ~~n~ 19B7 rID , I , " I Payment (Section 51527) (Continued) 0003 0005 0006 0007 0008 0009 0036 0037 0038 0039 0040 0041 0010 Mileage one way - per mile (mileage with patient on board) Night call - 7:00 p.m. to 7:00 a.m. Emergency run ~ Oxygen - per tank Neonatal intensive care incubator .,. Waiting time over 15 minutes - each 15 minutes Compressed air for infant respirator Extra attendant - RN, EMT, or Equivalent, (in addition to normal crew of two): First hour Second and third hour, each hour Each additional hour Cost of IV fluids (invoice must be attached) ECG in ambulance Unlisted Wheelchair Van and Litter Van Transportation Response to Call - Nonlitter Patient: 1 patient 2 patients, each patient 3 patients, each patient 4 or more patients, each patient Wheelchair use Response to call - Litter patient Attendant Waiting time over 15 minutes - each 15 minutes Mileage one way - per mile (mileage with patient on board) Night call - 7:00 p.m. to 7:00 a.m. Oxygen - per tank Unlisted 0015 0016 0017 0018 0020 0021 0023 0024 0025 0026 0028 0029 11 3.18 9.88 9.88 9.88 51. 49 9.88 10.23 16.44 11. 51 5.25 E Y Report 16.07 Ey Report c 14.71 ~ 11. 75 9.31 8.34 .74 21. 91 4.60 4.71 1.08 5.11 9.88 Ey Report Non-Emerqency Patient Transfer from Acute Care Facility to SNFjICF 0045 Response to call, ambulance 61. 71 0046 Ambulance mileage, one way-per mile 3.18 (mileage with patient on board) 0047 Response to call, litter patient, litter 21~91 van transportation 0048 Response to call, nonlitter patient, 14.71 wheelchair van transportation 0049 Wheelchair/litter van mileage, one way-per mile 1.08 (mileage with patient on board) 0050 Wheelchair use, wheelchair/litter van .74 tr ans porta tion 0051 Oxygen, per tank 9.88 A-14a Allied HeaJth 114 Reprinted ~une 1987 , -, J,..I c~ CMTA ... o California Medical Transportation Association, Inc. January 3, 1990 To "'nom it may concern: The California Medical Transportation Association (CMTA) is a body which represents primarily nonemergency medical transportation providers throughout the state of California. The ~ITA is interested in promoting the highest level of care and professionalism among its membership and, in fact, within the industry at large. Nonemergency transportation services are usually rendered to those whose chronic illness has exhausted their firuu.cial resources and caused them to be Medi-Cal (California's Medicaid program) beneficiaries. These services are then regulated by Title XXII, California Regulatory Code. Nearly all of these services require prior authorization by the Medi-Cal program so utilization is severely controlled. With this in mind, the only determination of choice (for the user) is the level of service, Without competition, there can be no alternative and hence, no reason to maintain optimum service levels. The CMTA will not and can not take a position for or in opposition to its membership, or any provider of nonemergency medical transportation. The CMTA will, however, point out that the free enterprise system is based on competition for cost, quality and survival. \~ile emergency ambulance service might need some restraints due to the urgent nature of that service and, thus, limit the ability of clients to "shop" for an appropriate or alternative service (it is hard to make an objective choice when one is experiencing chest pains!). Nonemergency medical transportation, on the other hand, does not need the same restraints because there is always time and usually a long term relationship in which to make a comparison. The CMTA stands for the free enterprise system wherein the costumer makes a decision based on price and quality of service and the better providers of service prevail. ~relY Yo~ ~r~P Executive Director ~ g~ cY/ Tom Egan V ~ President P.O. Box 296 · San Bruno, California 94066 . (415) 877-8250 . CITY OF SAN BERNJtrCDINO - REQUEST FOil COUNCIL ACTION STAFF REPORT The current dialysis transportation provider, Care Ambulette Service, Inc., was granted a franchise on May 28, 1981 to transport dialysis patients to and from San Bernardino Valley Dialysis Center located at 1500 North Waterman Avenue in the City of San Bernardino. The franchise permits Care Ambulette Service, Inc. to operate two dialysis transportation vehicles within the City. On August 19, 1985 Southwest Medical Transport, Inc. located at 1802 East Cedar, Suite A, Ontario, California was granted a franchise to operate three dialysis transportation vehicles. How- ever Southwest Medical Transport, Inc. subsequently went out of business leaving Care Ambulette Service, Inc. as the sole provider. At their meeting of February 13, 1990 the Bureau of Franchises recommended that a second dialysis transportation provider, Health- link, located at 11175 Mountain View, Suite L, Loma Linda, California be granted a franchise to operate two dialysis transportation veh:i,~les. The Bureau of Franchises based its recommendation on testimony by j social workers from Loma Linda University Medical Center and letter of recommendation by Dr. Kovalich, Medical Director of the San Bernardino Valley Dialysis Center. The Bureau of Franchises also placed a high priority on what would be most beneficial to the dialysis patients. The two dialysis transportation franchises would provide patients with a choice of providers. Consideration was given to the competitive aspect of having two dialysis transportation providers and the positive effect this would have regarding service. Healthlink owners Mr. Gary Fritzsche and Mr. Leo Castillo have complied with all requirements set forth in Municipal Code Chapter 5.76 relative to dialysis transportation. This includes proof of insurance and payment of the franchise permit filing fee. Rates for dialysis transportation charged by Healthlink will be the rates established by the Medi-cal Program of the State of California. 75-0264