Title
Recommendation to Ratify the City Manager's Execution of the Second Amendment to the Ambulance Transport Services Agreement with the County of Alameda to Accept Reimbursement Funds for the Alameda CARE Team's Response to Certain 911 Calls. (Fire 3200)
Body
To: Honorable Mayor and Members of the City Council
From: Gerry Beaudin, City Manager
EXECUTIVE SUMMARY
In November 2019, the City Council authorized the City Manager to execute an Emergency Medical Services (EMS) Ambulance Transport Services Agreement (Agreement) with the County of Alameda (County), enabling the City of Alameda (City) to continue providing ambulance transport services and to be reimbursed through City-established User Fees. On May 14, 2024, a first amendment was executed with no substantive changes, as permitted by the text of the Agreement. The County has since asked the City to execute a Second Amendment to the Agreement (Exhibit 1) to allow time for the County to continue to explore a possible re-design of the EMS service delivery model countywide and will provide the City with reimbursement for responses handled by the Alameda Fire Department's Alameda CARE Team, which pairs a paramedic with a behavioral health clinician to respond to certain low-acuity and behavioral health-related 911 calls instead of a traditional advanced life support (ALS) ambulance response. It is recommended that the City Council ratify the City Manager's execution of the Second Amendment.
BACKGROUND
Under Health and Safety Code Section 1797.201, the City is an authorized provider of basic life support, ALS, and emergency ambulance transport services within the City. To operate ALS services, the City must maintain a written agreement with the County's Local Emergency Medical Services Agency (LEMSA) delegating that authority to the City. In 2019, City Council authorized the City Manager to execute two separate five-year agreements with the County, each with the option of up to a five-year extension: 1) the EMS FRALS Services Agreement; and 2) the Ambulance Transport Services Agreement (Exhibit 3).
Since 2021, the Alameda Fire Department has operated the Alameda CARE Team, a co-response program that pairs a Fire Department staff member with an on-call behavioral health clinician to respond to behavioral health-related calls for service within Alameda. The CARE Team's model is intended to connect residents with appropriate care and resources while reducing unnecessary ALS ambulance responses and transport.
The County EMS Agency has recognized the value of the CARE Team's approach in appropriately triaging and, where clinically appropriate, diverting certain calls away from a traditional ALS ambulance response and Emergency Rooms. In 2025, the CARE Team interacted with 701 clients and transported 253. To support this work, the County and the City discussed options to assist with offsetting the costs associated with the CARE Team operations. The Second Amendment to the Ambulance Transport Services Agreement will provide some reimbursement to the City for CARE Team transport.
DISCUSSION
The Second Amendment allows the County to reimburse the City for a portion of the cost of CARE Team client transport, recognizing that these transports reduce the need for traditional ALS ambulance transport while still ensuring clients receive an appropriate level of care. The City shall be provided with a set rate of $1,006.36 for each non-medical behavioral health transport. For Fiscal Year (FY) 2026-27, total reimbursement shall not exceed $482,680. Currently, the CARE Team is funded through the General Fund and, since its inception in 2021, has used a mix of General Fund, state & federal funds, and Alameda Health Care District funding to sustain operations. This will be the first funding provided by the County. The City intends to continue discussion with the County as they explore a county-wide re-design of EMS services that include Mobile Integrated Health Programs such as the CARE Team, with the intention of identifying long-term funding support for the CARE Team. The Second Amendment does not change the underlying term, scope, or other provisions of the Ambulance Transport Services Agreement previously authorized by City Council and will expire June 30, 2027.
To avoid a lapse of the existing agreement and to ensure timely compliance with applicable state law regarding Alameda County's delegated authority to the City to operate First Responder Advanced Life Support services, the City Manager signed the Agreement on July 15, 2026. Staff and the City Manager consulted with the City Attorney's Office and confirmed that the City Manager had authority to accept the additional funds from the County.
Notwithstanding the City Manager's authority, staff requests City Council ratify the signed Second Amendment due to the substantive change related to the addition of reimbursed funds to eliminate any ambiguity as to whether the City can receive the additional funds from the County.
Following City Council ratification, staff will continue working with the County EMS Agency to track and report qualifying CARE Team responses and associated reimbursement.
ALTERNATIVES
• Ratify the City Manager's execution of the Second Amendment, as recommended, allowing the City to receive reimbursement from the County for CARE Team responses without ambiguity.
• Do not ratify the Second Amendment. This is not recommended, as it could create ambiguity as to whether the City may accept and retain reimbursement funds under the signed Second Amendment.
FINANCIAL IMPACT
The Second Amendment is expected to provide the City with additional annual reimbursement revenue of approximately $275,000, to be deposited into the Fire Department's General Fund (3200) and used to support the ongoing operation of the CARE Team. There is no change to the City's existing budgeted expenditures as a result of this action.
MUNICIPAL CODE/POLICY DOCUMENT CROSS REFERENCE
This action is consistent with the Alameda Municipal Code and City Purchasing Policy.
ENVIRONMENTAL REVIEW
This action does not constitute a "project" as defined in the California Environmental Quality Act (CEQA) Guidelines Section 15378, and therefore no further CEQA analysis is required.
CLIMATE IMPACT
There are no identifiable climate impacts or climate action opportunities associated with the subject of this report.
RECOMMENDATION
Ratify the City Manager's execution of the Second Amendment to the Ambulance Transport Services Agreement with the County of Alameda to accept reimbursement funds for the Alameda CARE Team's response to certain 911 calls.
Respectfully submitted,
Nicholas Luby, Fire Chief
Financial Impact section reviewed,
Ross McCarthy, Finance Director
Exhibits:
1. Second Amendment to the Ambulance Transport Services Agreement
2. First Amendment to the Ambulance Transport Services Agreement
3. EMS Ambulance Transport Service Agreement between County and City