Title
Recommendation to Authorize the Interim City Manager to Negotiate and Execute a Third Amendment to the Agreement with the County of Alameda Extending the Term of the Community Paramedicine Pilot Program by 12 Months; and
Adoption of Resolution Amending the Fiscal Year 2018-19 Budget for the Fire Grants Fund by $125,000 for Costs Associated with the Extension of the Community Paramedicine Pilot Program and the General Fund by $125,000 for the City Contribution to Fund the Program. (Fire 220)
Body
To: Honorable Mayor and Members of the City Council
From: David L. Rudat, Interim City Manager
EXECUTIVE SUMMARY
The Community Paramedicine Pilot Program has been extended by one additional year to five years in total. Alameda County has committed an additional $104,396 through a Third Amendment to the funding agreement with the City. In order to continue the Pilot Program through its completion, the Fire Department is asking the City Council to commit and appropriate an additional $195,604 in funding from the General Fund.
BACKGROUND
The State of California Emergency Medical Services Agency (EMSA) began accepting letters of intent for their two-year Community Paramedicine Pilot Program on July 18, 2013. The Pilot Program seeks to achieve efficiencies and enhance services in community-based health care by providing training to Paramedics in 11 jurisdictions throughout California. On October 24, 2013, the City of Alameda Fire Department was provisionally accepted by the EMSA to represent Alameda County in the Community Paramedicine Pilot Program. On July 29, 2014, City Council authorized the Fire Department to participate in the Community Paramedicine Pilot Program. To staff the program, an Emergency Medical Services Division Chief and two Community Paramedic Firefighter positions were redeployed for the duration of the funding. This resulted in a backfill through the ranks with regular fire staff, including hiring of three limited term firefighters. On January 22, 2015, the City Manager entered into a funding agreement with the County of Alameda, which initiated the Fire Department’s participation in the Pilot Program.
DISCUSSION
The goal of the Community Paramedicine Pilot Program is to determine whether Paramedics working in an expanded role will help improve overall health systems integration, efficiency and/or fill identified healthcare needs. By participating in this Pilot Program and testing the Program’s theories, the County of Alameda, working with the EMSA, generates, collects, and analyzes data that is being used to examine the practice of community paramedicine and serve as a basis to recommend changes to existing statute and regulations. The Alameda County Pilot Program includes two of the six aspects identified for the EMSA Program. They are:
1. Identify frequent callers of the 911 system and assist them in accessing primary care and social services; and
2. Provide follow-up-care for persons recently discharged from the hospital and at increased risk of a return to the Emergency Room or readmission to the hospital.
In November 2017, the Office of Statewide Health Planning and Development (OSHPD) extended the Community Paramedicine Pilot Program from three years to four years in order to collect additional data needed to fully analyze the outcomes of the Pilot Program, as well as determine the future of Community Paramedicine in the State. At that time, the City of Alameda, the Alameda County Health Care Services Agency (HCSA), and the Alameda County Emergency Medical Services Agency committed equal funding to continue through the end of the pilot program.
In November 2018, OSHPD extended the Community Paramedicine Pilot Program again from four years to five years in order to continue collecting data and fully analyze the outcomes of the Pilot Program. In response to the extension, the Alameda County Emergency Medical Services Agency has committed an additional $104,396 in funding to continue through the end of the pilot program.
The agreement with the County of Alameda will be amended as follows:
• Increase the amount by $104,396 bringing the total contract amount to $2,186,492;
• Extend the term of the contract by 12 months.
At this time, no other agencies have committed additional funding to the Community Paramedicine Pilot Program. If the Pilot Program is to continue, it is imperative that the City join the County in providing additional funding.
In response to the shortage of additional funding sources, the department scaled back the program to lessen the impact on the City’s budget in December 2018. Staffing was reduced from one Division Chief and two Firefighters to one Division Chief and one Firefighter, which reduced the amount of required backfill on suppression. As a result of this change, the total cost of continuing the program through February 2020 is $300,000.
With the reduction in staffing, the department, in coordination with the County, also adjusted the scope of the program to focus primarily on the City’s homeless population. The Community Paramedics are capable of assisting local homeless clients with patient aftercare plans coordinated by social workers within the healthcare system. When homeless clients are released from the hospital, it can be difficult for social workers to follow up with them regarding prescription discharge medications, scheduled physician/specialist visits, etc. The Community Paramedics are able to meet with these homeless clients out in the field to ensure that their aftercare goals are met.
The Community Paramedics have, and will continue to, assist their homeless clients with an array of issues, including:
• Placement in detox/sobering centers
• Placement in drug/alcohol rehabilitation programs
• Acquiring California identification cards
• Acquiring Alameda County Electronic Benefit Transfer (EBT) cards
• Enrollment in CalWorks and CalFresh benefit programs
• Housing assistance (temporary and permanent)
• Transportation assistance (enrollment in East Bay Paratransit, taxi vouchers, etc.)
• Providing food vouchers and clothing as needed
• Referral to existing and/or new Primary Care Providers
• Mental health psychologist referrals and evaluations
• Prescription medication picked up and delivered
• Emergency domestic violence shelter placements
• Job and volunteer opportunity placements
• Cleaning of hazardous living conditions
• Connection with family (distant and close)
• Pet food attained and delivered in coordination with FAAS
The total cost to continue the Community Paramedicine Pilot Program through February 2020 is $300,000. Alameda County has committed an additional $104,396 in funding. In order to continue the Pilot Program through its completion, the Fire Department is asking the City Council to commit and appropriate an additional $195,604 in funding from the General Fund.
As the program was originally approved, there was no funding commitment to the City or expectation on the part of Alameda County that funding for the original three positions will continue at the conclusion of the funded period. Therefore, once the funding concludes, the additional Division Chief and two Firefighter positions were to be eliminated from the Fire Department’s authorized staffing.
In November 2019, the Fire Department will come back to City Council to discuss legislative changes and funding sources, as well as the permanent continuance of the Community Paramedicine program in the City of Alameda.
FINANCIAL IMPACT
During the Mid-Cycle Budget Update, the City appropriated sufficient funds to fund the program until November 2018. Since November, the staffing for the program was reduced from three positions (EMS Division Chief and two Community Paramedic Firefighters) to two positions (EMS Division Chief and one Community Paramedic Firefighters). Reduction in the number of positions allowed for decreased cost, which is being absorbed within the current General Fund allocation to the Program, and continuation of the program through February 2019.
The total cost to continue the Community Paramedicine Pilot Program to February 2020 is estimated at $300,000 of which Alameda County is committed to providing funds of $104,396. Staff’s recommendation is to continue the program and to authorize the City’s General Fund to fund the remaining $195,604. The funding will be managed by the Fire Department and will be accounted for in the Grants Fund. To cover the cost of the program through the end of the Fiscal Year 2018-19, the Grants Fund revenue and expenditures budget will need to be increased by $125,000. The remaining $175,000, of which $70,604 will be allocated from the General Fund, will be included in the revenue and expenditures budget for FY 2019-20 as part of the regular biennial budget process. At the end of FY 2018-19, any unspent appropriations will be carried over and re-appropriated in FY 2019-20.
|
Fund/Account |
Amount |
|
General Fund (001) |
|
|
Transfer Out |
$125,000 |
|
Grants Fund (220) |
|
|
Transfer In |
$125,000 |
|
Grant Revenue |
|
|
Expenditures |
$125,000 |
MUNICIPAL CODE/POLICY DOCUMENT CROSS REFERENCE
This action is consistent with the Municipal Code.
ENVIRONMENTAL REVIEW
This action is not a project for the purposes of the California Environmental Quality Act (CEQA) under CEQA Guidelines section 10561(b)(3) as there is no possibility that this action may have a significant effect on the environment.
RECOMMENDATION
Authorize the Interim City Manager to negotiate and execute a third amendment to the agreement with the County of Alameda extending the term of the Community Paramedicine Pilot Program by 12 months; and
Adopt a Resolution amending the Fiscal Year 2018-19 budget for Fire Grants Fund by $125,000 for costs associated with the extension of the Community Paramedicine Pilot Program and the General Fund by $125,000 for the City contribution to fund the Program.
Respectfully submitted,
Edmond Rodriguez, Fire Chief
By,
Darci Vogel, Fire Admin Services Manager
Financial Impact section reviewed,
Elena Adair, Finance Director
Exhibits:
1. Original Contract, 2015
2. 1st amendment, 2017
3. 2nd amendment, 2018