Sonoma County Municipal Code § 28-6 Ambulance service provider permits

(a) All EMS entities operating in the county shall be authorized by the LEMSA in accordance with the requirements of this chapter, LEMSA policy and applicable law.

(b) Authorization shall consist of a provider agreement and, if indicated for the type of EMS entity, an ambulance service provider permit.

(Ord. No. 6294, § I, 11-12-2019)

(a) Any entity (either as an owner, agent or otherwise) who wishes to furnish, operate, conduct, maintain, or otherwise engage in, or offer, or profess to engage in providing ambulance service in the county shall have a valid ambulance service provider permit in accordance with the LEMSA system plan and EMS policies, procedures, and guidelines.

(b) Permit requirements shall apply to providers of air and ground ambulances, including BLS, ALS and CCT vehicles.

(c) Public agencies operating as EMS entities are exempt from the LEMSA permitting process but shall be subject to all the policies and procedures of the LEMSA.

(d) Ambulances based and properly licensed outside Sonoma County may transport patients within Sonoma County without compliance with this chapter provided:

(1) They do not operate within any of the designated exclusive operating areas within Sonoma County unless given express permission to do so by the LEMSA.

(2) The patient is being transported to a residence or facility within Sonoma County from a residence or facility outside of the county, or

(3) The patient is being transported through Sonoma County to a destination outside the county, or

(4) The patient was transported into the county by the same operator and is to be transported back to the county of origin, or

(5) An agreement exists between contiguous counties for emergency medical services by ambulances.

(e) LEMSA Policy shall specify process for the issuance of ambulance service provider permits.

(f) Permit holders shall be required to obtain a provider agreement for the level of service to be provided as a condition of obtaining and holding a valid permit.

(g) Permits shall be valid until revoked, suspended or as conditioned by the LEMSA.

(Ord. No. 6294, § I, 11-12-2019)

(a) Any EMS entity providing advanced life support, ambulance service, or other EMS services requiring LEMSA authorization or approval in accordance with California Health and Safety Code or California Code of Regulations or this chapter within the county shall secure a provider agreement from the LEMSA specifying terms and conditions for the services to be provided unless exempted by this chapter.

(1) Operators of BLS, CCT and air ambulances shall enter into provider agreements for the level of service per the requirements of their ambulance service provider permit.

(2) Paramedic service provider agreements as required by CCR Title 22 section 100168 shall be considered provider agreements for the purpose of this chapter and, if applicable, meet the requirements of an ambulance service provider permit.

(b) Exemptions:

(1) Non-transport public EMS entities are exempt from the requirement to secure a provider agreement with the LEMSA except where specific LEMSA authorizations for EMS scope of practice are required by California Health and Safety Code and/or California Code of Regulations.

(2) City and special districts operating ALS ambulance services pursuant to Section 1797.201 are exempt from the requirement to secure a provider agreement with the LEMSA.

(3) EMS Entities exempted from the requirement to enter in agreements by 28-7 (2)(a) and (b) are nonetheless required to comply with all LEMSA policies and Sections 28-19, 28-20 and 28-21 of this chapter shall apply.

(Ord. No. 6294, § I, 11-12-2019)

(a) Emergency ambulance service zones shall be defined in the emergency medical services plan (EMS Plan). Changes to zone boundaries or to the emergency ambulance service provider agencies designated as the provider(s) for that zone must initiate with the qualified elected governing entity (QEGE) or entities of the area affected by the change and be directed to the LEMSA for action as follows:

(b) Request for changes to zone boundaries or to the provider of emergency ambulance services shall take the form of a letter of support for the change authorized by an action of the QEGE governing body from the QEGE to the LEMSA.

(c) Requests for changes within the boundaries of a special district that is designated within the EMS plan as the provider of emergency ambulance services for that area shall initiate with the special district board of directors.

(d) Requests for changes within the city limits of an incorporated city that is designated within the EMS plan as the provider of emergency ambulance services for that area shall initiate with that city council.

(e) Requests for changes outside of the boundaries of a city or special district that is designated within the EMS plan as the provider of emergency ambulance services for that zone shall initiate with the Sonoma County Board of Supervisors.

(f) Requests for changes in an EMS zone that includes multiple QEGEs must initiate with one (1) entity and have the support of each QEGE in the zone with respect to the properties within their jurisdiction.

(g) Requests for a change to the designated emergency ambulance service provider in areas where the currently designated provider is a city or special district must also be supported by that QEGE in a noticed public meeting. The LEMSA shall be provided notice at least ten (10) days prior to the public meeting at which the request is to be heard.

(h) If any of the applicable QEGEs take an action to oppose a requested change in the ambulance provider, or fail to include an action to consider support of a request for a requested change on a regularly scheduled public meeting within ninety (90) days of receipt of a certified letter seeking such action, the LEMSA may render a decision based upon the input from responsive QEGEs.

(1) If a QEGE board declares a right to exclusively operate emergency ambulance service within its boundary as defined by California Health and Safety Code Section 1797.201, and opposes a change in ambulance service provider, the LEMSA shall take no action to displace the QEGE provider or to authorize another EMS entity within the QEGE boundaries.

(i) A QEGE may request that the LEMSA establish exclusivity within a zone according to HSC 1797.224 as follows:

(1) An existing provider agency that may be eligible for grandfathering into an exclusive operating area without a competitive process shall be evaluated for eligibility following the request by a QEGE.

(2) An existing zone, without a grandfathering-eligible provider agency, may have exclusivity established through a competitive process at the request of a QEGE

(j) The LEMSA will consult with the local agency formation commission (LAFCO) on any proposed change by the LEMSA that affects matters within LAFCO's jurisdiction.

(k) The LEMSA shall take into account an evaluation of medical appropriateness and the operational impact on the coordinated system of care when deliberating a change in zone providers.

(l) Upon completion of the deliberation process, the LEMSA may make the requested change, deny the change, or conduct a competitive bid process according to California Health and Safety Code Section 1797.224.

(m) Any QEGE or EMS entity affected by the LEMSA decision may request a hearing as provided in section 28-21 of this chapter.

(Ord. No. 6294, § I, 11-12-2019)

(a) In order to support the planning, monitoring and periodic review of an economically sustainable, high quality and equitable EMS system, the LEMSA shall leverage all available data sources. The LEMSA shall collect and use data in the following ways:

(1) EMS Entities providing prehospital care within Sonoma County shall complete documentation and submit electronic patient care data consistent with statute and regulations as well as any local requirements per LEMSA policy.

(2) LEMSA shall collect financial data at a minimum showing:

a. source of payment for EMS services,

b. service provider rates,

c. collection data, and

d. actual charges to patients served.

(3) The LEMSA shall collect data regarding the EMS entities' responses into other provider agencies' assigned service areas.

(4) Hospitals and any other healthcare facilities receiving EMS patients shall provide patient outcome data in conformity with state statute and regulations as well as any local requirement per LEMSA policy.

(5) LEMSA shall promulgate policy to address type of information reported, creation of local requirements for data submission, conditions for access and use of information provided and mechanisms for maintaining confidentiality of patient information in accordance with state and federal statute and regulations that are relevant to such data security.

(6) Adherence to LEMSA data submission policy shall be a condition of any distribution of funding, specialty care designation and/or Medicare authorization issued by the LEMSA to any entity operating under the medical control of the EMS agency, or receiving ambulance patients within Sonoma County.

(7) Any agreement between the LEMSA and a system participant shall contain a clause reinforcing the expectations stated herein.

(8) Data collected by the LEMSA shall be used to inform the LEMSA, EMCC and board of supervisors about the status and performance of the EMS system as part of periodic review and ongoing planning efforts.

(Ord. No. 6294, § I, 11-12-2019)