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Home My WebLink AboutBOARD STANDING COMMITTEES - 12032018 - Finance Cte Agenda Pkt FINANCE COMMITTEE December 3, 2018 1:00 P.M. 651 Pine Street, Room 108, Martinez Supervisor Karen Mitchoff, Chair Supervisor John Gioia, Vice Chair Agenda Items: Items may be taken out of order based on the business of the day and preference of the Committee 1.Introductions 2.Public comment on any item under the jurisdiction of the Committee and not on this agenda (speakers may be limited to three minutes). 3. CONSIDER approving the Record of Action for the July 23, 2018, Finance Committee meeting (Lisa Driscoll, County Finance Director) 4. CONSIDER accepting the Quarterly Capital Projects Report (Ramesh Kanzaria, Capital Projects Division Manager/Public Works) 5. CONSIDER report and request on EMS System Funding Recommendations (Patricia Frost, Director, Emergency Medical Services) 6.The 2019 calendar is not yet established. 7.Adjourn The Finance Committee will provide reasonable accommodations for persons with disabilities planning to attend Finance Committee meetings. Contact the staff person listed below at least 72 hours before the meeting. Any disclosable public records related to an open session item on a regular meeting agenda and distributed by the County to a majority of members of the Finance Committee less than 96 hours prior to that meeting are available for public inspection at 651 Pine Street, 10th floor, during normal business hours. Public comment may be submitted via electronic mail on agenda items at least one full work day prior to the published meeting time. For Additional Information Contact: Lisa Driscoll, Committee Staff Phone (925) 335-1021, Fax (925) 646-1353 lisa.driscoll@cao.cccounty.us FINANCE COMMITTEE 3. Meeting Date:12/03/2018 Subject:Record of Action for July 23, 2018 Finance Committee Meeting Submitted For: FINANCE COMMITTEE, Department:County Administrator Referral No.: N/A Referral Name: Record of Action Presenter: Lisa Driscoll, County Finance Director Contact: Lisa Driscoll (925) 335-1023 Referral History: County Ordinance requires that each County body keep a record of its meetings. Though the record need not be verbatim, it must accurately reflect the agenda and the discussions made in the meetings. Referral Update: Attached for the Committee's consideration is the Record of Action for its July 23, 2018 meeting. Recommendation(s)/Next Step(s): Staff recommends approval of the Record of Action for the July 23, 2018 meeting. Fiscal Impact (if any): No fiscal impact. Attachments Draft Record of Action July 23, 2018 FINANCE COMMITTEE 4. Meeting Date:12/03/2018 Subject:QUARTERLY CAPITAL PROJECTS REPORT Submitted For: FINANCE COMMITTEE, Department:County Administrator Referral No.: 1/6/2009 SD.2 Referral Name: Quarterly Capital Projects Presenter: Ramesh Kanzaria, Capital Projects Division Manager Contact: Brian Balbas (925) 313-2284 Referral History: On January 6, 2009, the Board of Supervisors approved recommendations for Board Member appointments to local, regional and statewide boards, committees and commissions for the 2009 calendar year. One of the adopted recommendations was to combine the Capital Facilities Committee with the Finance Committee. On February 2, 2009, the Finance Committee met and planned committee meetings and schedules for the coming year. One of the recommendations was for the Finance Committee to receive regular capital facility update reports. The first report was presented to Finance on March 4, 2009 by the Director of General Services, Mike Lango. The Committee reviewed the initial report and requested that additional financing and appropriation information be added to make the report more meaningful. The final report format was accepted at the April 6, 2009 meeting and staff was directed to include on future Finance Committee agendas. Reports were submitted at each Finance Committee meeting through December 2010. Beginning in 2011, the Finance Committee requested that Capital Facility Reports be reviewed quarterly. Quarterly review of Capital Facility Reports is the current practice. Referral Update: Quarterly update. Per Committee request the report elements have been updated. The Capital Projects report is now broken-out by stages - feasibility, design and estimates. Projects under construction are also identified. The FLIP Projects report now break-outs the “in progress” projects for both Capital projects and Facilities Maintenance, and “completed” projects for both Capital projects and Facilities Maintenance are identified and include a completion date. Recommendation(s)/Next Step(s): ACCEPT Quarterly Capital Projects update. Attachments Quarterly Capital Project Report 10-15-2018 FINANCE COMMITTEE 5. Meeting Date:12/03/2018 Subject:Contra Costa EMS System Funding Report Submitted For: Anna Roth, Health Services Director Department:Health Services Referral No.: 5-23-17 D.6 Referral Name: County Service Area EM-1 Basic Assessment Presenter: Patricia Frost (925) 646-4690 Contact: Patricia Frost, Director, EMS Referral History: On July 23, 2018, the Finance Committee heard an update to the March 26, 2018 report to consider funding identified system needs of $550,000. The Committee briefly discussed the financial needs of the system and discussed the pursuit of a Special Tax for EMS. In March, the Committee directed an on-going referral to Finance to begin working on the two year process to put a Special Tax on the June 2020 ballot. Staff was directed to forward a report to the Board to recommend exploration of a ballot measure for a Special Tax to support EMS and other health related issues and to direct the County Administrator to develop a plan to bring back to the Committee by the end of 2018. Staff was directed to work with Ms. Frost to meet with the CCC Fire Chiefs Executive Board to discuss such a measure. The Committee directed that the meeting is to occur by the end of September to allow the item to return to Finance in October. On March 26, 2018, the Finance Committee heard a report and request for funding from Patricia Frost. The Committee discussed the financial needs of the system, possible State legislation to address the need, pursuit of a Special Tax, and future grant opportunities. The Committee directed Ms. Frost to forward a report to the Board to recommend exploration of a ballot measure for a Special Tax to support EMS and other health related issues and to the direct the County Administrator to develop a plan to bring back to the Committee by the end of 2018. The Committee next moved to address some of the current financial gaps and initially recommended gap-funding. However, due to lack of clarity regarding the Health Information Exchange (HIE) grant, the Chair asked that the item be returned to Committee. On May 23, 2017, the Board of Supervisors referred the matter of an increase in the basic assessment fee for County Service Area EM-1 to the Finance Committee after a hearing to consider a tentative report on the proposed assessment for the 2017/18 fiscal year. On October 23, 2017, the attached report was submitted for consideration by the Committee. A presentation by Patricia Frost, Director of Emergency Medical Services, was provided to the Committee. The referral was to consider an increase to the basic assessment rate for County Service Area EM-1; however, the focus of the report was on system needs rather than funding. Ms. Frost was directed to return to Committee with a full report of need and recommendations on funding in February. Referral Update: The attached report and attachments are submitted for consideration. Recommendation(s)/Next Step(s): CONSIDER report and request by the Director of Emergency Medical Services on EMS System Funding Recommendations. Attachments EMS Finance Update County of Contra Costa EMERGENCY MEDICAL SERVICES Memorandum DATE: December 3, 2018 TO: FINANCE COMMITTEE Supervisor Karen Mitchoff, District IV, Chair Supervisor John Gioia, District I, Vice Chair FROM: Patricia Frost, Director, Emergency Medical Services SUBJECT: Contra Costa EMS System Funding Report Information: Referral History: On March 19, 2017, the EMS Agency submitted a follow-up report on Community Service Area EM-1 (Measure H) and EMS System funding gaps. The report included two key recommendations to assure continuity of technology operations required to meet Title 22 EMS System program unfunded mandates supporting life-saving programs for Trauma, Cardiac Arrest, STEMI, Stroke and EMS for Children. Recommendation #1: Establish an interim annual EMS System Program enhancement contribution/investment of up to $750,000 1from available Board designated revenue sources until such time a new benefit assessment or other revenue source with a COLA could be established to support and enhance the Countywide EMS System. Committee Response: The Finance committee approved general fund allocation of $550,000. Committee Update: The EMS Director was asked to provide clarifying information associated with the requirement for bi-directional exchange, current efforts to promote Countywide EMS System compliance with the requirement and an update on the State CMS grant to promote EMS bi-directional exchange. This information is summarized in the attached letter dated Oct 30, 2018 on EMS System Bi-directional Exchange Update to CCHS leadership at the request of Supervisor Mitchoff (as attached). 1 In 2014 the Contra Costa EMS System Modernization Study identified the need for an additional $750,000 to sustain Countywide EMS System of Care programs. 2 Bi-directional exchange is an EMSA state requirement of Local EMS Agencies to work with their EMS systems (fire, ambulance, hospital) to create an interoperable EMS patient electronic medical records exchange with receiving hospitals to improve patient care and save lives. Bi- directional capability allows EMS providers in tracking and preventing disruptions in patient care during disasters such as Hurricane Florence, wildfires and any emergency event where evacuation of health care facilities occurs. Bi-directional exchange has known benefits in other states where successful EMS-health care integrated systems support alternative destination to clinics, sobering centers and urgent care. Bi-directional exchange allows EMS Systems to partner “smarter” with the ability to alert the appropriate health care entity of that one of their patients had a 911 response regardless of if they were taken to an emergency room. The illustration below summarizes that capability. On August 27, 2018 the EMS Agency with the assistance CAO leadership (Lisa Driscoll, Julie Enea and Paul Reyes) met with the Leadership for the Fire Executive Chiefs (Fire Chief Paige Meyer San Ramon Valley Fire Protection District and Fire Chief Lance Maples El Cerrito/ Kensington Fire District) to discuss a broad range of issues including bi-directional exchange and the state of Contra Costa EMS System funding. During the meeting the Fire Executive Chiefs acknowledged that they fully understood that bi-directional exchange was a state requirement there were fiscal matters associated with the long term costs to support bi- directional exchange for the county fire districts and expressed the need for more evidence that 3 the capability helped EMS personnel save lives. They advised that the fire districts were “cost adverse” and unwilling to take on new programs and projects even in response to state requirements when sustainable funding was not in place. The EMS Agency was asked to provide information to the Fire Executive Chiefs on the experience of fire-based bi-directional exchange experiences in California and out of state. On September 10th the EMS Director provided Chief Meyer, Chief Maples and Chief Carman information obtained from San Diego Fire and Rescue on their real world experience. San Diego County has the most mature, well-funded EMS bi-directional exchange system in California. The capability is being held out as a model by the State EMS Authority supporting opportunities for robust integration of services between health systems, county public services health and human services and public safety. In addition the immediate primary benefit for fire services providing ambulance services was in the area of timely and accurate billing that improved reimbursement and efficiency in billing. San Diego Fire stated it had significantly reduced the number of self-pay bills due to lack of payer information. For those field level fire first responders and EMS ambulance personnel they reported that the “Search” function of bi-directional exchange offered paramedics critical information including allergies, current medications, patient history and that Fire-EMS responders now rely on that information to treat the patient. Since then Fire Executive Chiefs Carmen, Meyer and Maples all jointly advised the EMS Director that they were not interested in participating in this round of the upcoming CMS grant. Recommendation #2: Preserve and enhance the Fire First Responder funding by an additional 2 million dollars by moving forward by exploring a long term funding measure. Committee Response: The Finance committee discussed long term EMS System funding needs and recommended working on the two year process to put a Special Tax on the June 2020 ballot. Chief Carman and EMS Director were directed to solicit input from stakeholders and Fire leadership. Committee Update: During the August 27, 2018 EMS System sustainable funding was discussed. Chief Lance Maples and Chief Paige Meyer informed parties that the fire districts of the Rodeo Hercules, Pinole and East County had no interest in participating in a county wide EMS ballot measure due to their need to support their own ballot measure. They also expressed dis-satisfaction with the population based re-alignment Measure H funding recommended by the CAO and approved by the Board of Supervisors in response to the economic downturn that was previously “engine-based”. Subsequent to this meeting the EMS Director solicited some limited interest in enhancement of the EMS System associated with technology and equipment resources that would more directly demonstrate life-saving benefit. A letter was drafted on exploring a possible ballot measure directed at intra-operable data systems, public safety emergency communications and hi-tech 4 solutions including sustainable funding for EBRCS, First Net, WebEOC, Tablet Command, dispatch and numerous data system upgrades critical to EMS and public safety operations. A ballot measure benefiting Fire, EMS, Ambulance and Public Safety emergency and disaster technology to assure continuity of operations may be worthwhile to develop and explore. Letters of preliminary interest are attached to this report. Summary: Gaps in sustainable Emergency Medical Services funding threaten to degrade Contra Costa EMS System Services within the next 5 years with adverse impacts to all fire and ambulance stakeholders. Although the economy has improved in the short term fiscal sustainability discussions are occurring at every fire district and with every private ambulance provider supporting emergency and non-emergency medical transportation services. At the Contra Costa Fire Protection District Directors Meeting on September 18th Chief Carman reported that the district is just “getting by” at this point in time and has yet to fully recover from the prior fiscal downturn. Measure H funding is inadequate to provide for continuity of EMS System program operations, upgrades in technology infrastructure, and meet statutory requirements for EMT and paramedic oversight. Over the last 5 years increases in population growth have driven increased EMS service utilization. Expanded emergency and disaster operations have been tested and it is in the best interest of the county to establish an EMS System disaster contingency fund to assure sustainable funding streams. The Contra Costa EMS System is a high performance system with a level of medical complexity and patient volume that has increased 250% since Measure H was approved. The Local EMS Agency will require $ 750,000 in additional funding per year to meet state and federal regulatory requirements to support fire agencies paramedic based EMS services. Recent and upcoming salary increases approved by the Board of Supervisors are the key driver in EMS Agency personnel costs. The EMS Agency is constrained in its ability to achieve cost recovery and has exhausted its ability to raise fees and redesign internal operations through technology. Unlike other Local EMS Agencies in California, Contra Costa EMS Agency does not collect franchise or other first responder fees. In addition the EMS Agency has legacy of directing all ambulance contract performance penalties to support Fire-EMS stakeholders and EMS system improvement. I would like to that the finance committee executive leadership for this year’s general fund allocation supporting regulatory compliance. 40,780 103,596 Responses 29,774 80,733 Transports 0 20,000 40,000 60,000 80,000 100,000 120,000 1991-19921992-19931993-19941994-19951995-19961996-19971997-19981998-19991999-20002000-20012001-20022002-20032003-20042004-20052005-20062006-20072007-20082008-20092009-20102010-20112011-20122012-20132013-20142014-20152015-20162016-20172017-2018Number Contra Costa Emergency Medical Services EMS System Response and Transport Volume 1990-2017 Local EMS Agency cost of compliance with local, state and grant requirements for EMS Systems and Programs Local EMS Agency cost of compliance with local, state and grant requirements for EMS Systems and Programs 6 STEMI, $77,007, 5% Stroke $90,989, 5% Trauma $93,587, 6% Cardiac Arrest, $103,380, 6% Professional Standards $198,988, 12% EMS for Children, $39,106, 2% Disaster Preparedness , $252,994, 15% EMS System Quality and Medical Oversight $512,037, 30% Alliance Contract Compliance $231,000, 14% Other $76,473, 5% Contra Costa Emergency Medical Services EMS System of Care and Paramedic Program Support* FY 2017-2018 total $1,675,560 Local EMS Agency cost of compliance with local, state and grant requirements for EMS Systems and Programs HSAGHEALTHSERVICESADVISORYGROUPApril12,2018PatFrost,RN,MS,PNPDirector,EmergencyMedicalServicesContraCostaHealthServices1340ArnoldDrive,Suite126Martinez,CA94553DearMs.Frost,HealthServicesAdvisoryGroup(HSAG)iswritingthisletterinstrongsupportofyouragency’sapplicationforgrantfundingtoinitiatetheHealthInformationExchange(1-HE)projectforEmergencyMedicalServicesinContraCostacounty.WebelievethattheimplementationofanHIEbetweentheEMSprovidersandhospitalswillresultinimprovedcareinboththepre-hospitalandhospitalsettings.Thegrantfundingwillfacilitatea90/10matchingofFederalMedicaiddollarsthatwillbuildtheinfrastructureforthesecuremovementofpatientinformationandallowforbettermeasurementofqualitypatientcareandoutcomes.TheContraCostaEMSagencyiswellpositionedtoparticipateinthisproject.ThecountyisalreadyparticipatinginthePOLSTc-RegistryPilot.Inaddition,itisalsoparticipatinginanHSAGSpecialInnovationProjectfundedbytheCentersforMedicaidandMedicareServices(CMS)toimprovethestrokesystemofcareinthecounty.ContraCostaisalsoacountywhereHSAGhasorganizedacommunitycoalitionofproviderstoimprovecaretransitionsandcarecoordination.ReceivingthisgrantfundingtodesignandimplementanHIEarchitecturewillbuildadditionalcapabilitytoimproveoutcomesforcountyresidents.TheuscofhealthinformationexchangewillallowaccuratecommunicationofcriticaldatafromtheFirstrespondersandambulancetransporttothein-hospitalcareteammembers,especiallyfortreatmentrequiringtimesensitivetreatmentortherapysuchastrauma,heartattack,orstroke.AnintegratedinformationsystemwillalsoallowformoreefficienttransitionsofcareandbetterdecisionsupportfortheEMSproviderstodeliverthepatienttotheproperfacility.HSAGoffersstrongsupporttoyouragencytohelpachievefundingofthisimportantproject.WebelieveyouragencyhasacapableandtalentedleadershipteamthatisreadyandabletoreceivethegrantFundingfortheimplementationofaneffectiveWEthatwillultimatelyresultinbetterhealthoutcomesforthecountyresidents.Sincerely,Mary1E9&Dalton,Ph,BA,RNChicfSxecutiveOfficerHealthServicesAdvisoryGroup,Inc.3133EastCarnelbackRoad,Suite100,Phoenix,AZ850164545jPhone602.801.6600IFax602801.6051Iwvvhsagcorn