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HomeMy WebLinkAboutContract 16348 CITY SECRETARY CONTRACT � EMS INTERLOCAL COOPERATIVE AGREEMENT WHEREAS, the State of Texas, in the Interlocal Cooperation Act, has provided in Art. 4413(32c), Texas Civil Statutes, et seq., that this City (hereinafter called "this Jurisdiction") may jointly exercise with other local governments the power to provide governmental services for the public health and welfare, and such services include ambulance services; and WHEREAS, it is in the best interests of the public health and welfare of the people of this Jurisdiction to have available to them a state-of-the-art, high performance, high quality, prehospital emer- gency medical system, with stringent medical controls and accountability, and adequate response times; and WHEREAS, due to the relatively low population and low population density of some portions of the geographic area in Tarrant County, Texas, and the extremely high start-up and fixed operating costs of a state-of-the-art emergency medical system, it is necessary to award a single provider the right to engage in ambulance operations within this Jurisdiction, in order to maximize economies of scale for providing such emergency medical services. THEREFORE, be it resolved that this Jurisdiction hereby agrees to join with all other jurisdictions which adopt this Interlocal Cooperative Agreement, and this Jurisdiction agrees as follows; 1. There is hereby created an administrative agency, pursuant to Art. 4413(32c) Sec. 4(d), Texas Civil Statutes, called the Area Metropolitan Ambulance Authority, (hereinafter called the "Authority"). The Authority shall have all of the powers and duties set forth and described in Paragraph 8, below. This Jurisdiction elects to become a member of the Authority, by the adoption of this Agreement, and by the adoption concurrently of the Uniform EMS Ordinance (Exhibit A), and by the selection of a price/subsidy option from the Uniform Schedule of Price/Subsidy Options Effective August 1, 1988 -- December 31, 1989 (Exhibit D). untenocai L ooperattve Agreement, cont....) 2 2. The Authority's term of existence and provisions for withdrawal from membership in the Authority shall be as follows: ' (a) The existence of the Authority shall be perpetual. This Jurisdiction may not withdraw until July 31, 1993. Thereafter, this Jurisdiction may withdraw on July 31, 1996 and July 31, 1999. (b) Thereafter, the dates of this Jurisdiction's right to withdraw shall coincide with the termination dates of the competitively awarded contracts for ambulance services with the contractor, and the expiration dates of all options for extension thereof. This Jurisdiction's right to withdraw shall occur on the last day of each contract, or the last date of any option for extension thereof. Notice of such intention to withdraw shall be given in writing to the Authority, and to each member jurisdiction thereof not less than twelve (12) months before the proposed effective date of withdrawal. 3. The Authority's Board of Directors shall be composed of no more than nine members, constituted as follows: (a) Two members who are knowledgeable in health care administration, and who have resided for at least three years in a jurisdiction which is a member of the Authority; (b) Two members who are knowledgeable in finance, or accounting, and who have resided for at least three years in a jurisdiction which is a member of the Authority; (c) Two licensed attorneys in private practice, whose principal place of practice is a jurisdiction which is a member of the Authority, and who have resided for at least three years in a jurisdiction which is a member of the Authority; (Interlocal Cooperative Agreement, cont....) 3 (d) Two members who are experienced in business administration, and who have resided for at least three years in a jurisdiction which is a member of the Authority; (e) The Medical Director of the Emergency Physicians Advisory Board, who shall serve ex officio, but with voting rights. (f) The first Board of Directors shall have four members appointed for a term of two years, and the balance of the members of the Board shall be appointed for a term of three years. (g) Thereafter, the terms of office of all members of the Board of Directors shall be for a period of three years. No member of the Board shall be appointed for more than two consecutive terms in office. (h) No member of the Board of Directors shall have any interest, financial or otherwise, either directly or indirectly, in any firm or organization which is a bidder for the competitively awarded contract, or in any firm or organization which contracts to provide ambulance service to the Authority; (i) The membership of the Board shall be chosen as set forth below in Paragraphs 12 and 13. (j) Any member of the Board who fails to attend any three (3) consecutive, regularly scheduled Board meetings or who fails to attend at least six (6) regularly scheduled meetings in any twelve (12) month period, without a reasonable and valid reason for such absence shall be removed from the Board, and his position filled as provided in Paragraph 11, below. Removal of a member pursuant to this provision must be approved by a majority of the members of the board, excluding the member in question. (Interlocal Cooperative Agreement, cont....) 4 4. Requirements for membership in the Authority shall be as follows: (a) Membership in the Authority shall be open to any City in Tarrant County, Texas which executes and approves the Uniform Ordinance for Ambulance Services and this Interlocal Cooperative Agreement no later than July 15, 1988, and which selects a price/subsidy option from Exhibit D, Uniform Schedule of Price/Subsidy Options Effective August 1, 1988 -- December 31, 1989. Rural Fire Prevention District Number One of Tarrant County may become a member of the Authority by adopting and executing this Interlocal Cooperative Agreement, and by selecting a price/subsidy option from the Uniform Schedule of Price/Subsidy Options. However, the Authority shall provide ambulance services only in those portions of the unincorporated areas of Tarrant County which are operationally contiguous to member jurisdictions of the Authority, as determined by the Authority. (b) Thereafter, membership shall be open, on an annual basis, to any city which is in Tarrant County, Texas or to any jurisdiction which is contiguous to the geographic area served by the Authority, if such City is not located in Tarrant County, Texas, subject to approval by the Authority. (c) Any jurisdiction which becomes a member after July 15, 1988 shall be required to pay a one-time initial capital assessment which is equal to that jurisdiction's per-capita share of the Capital Account of the Authority. Such payment of the pro-rata share of the Capital Account may be paid: (1) By a one-time payment at time of joining; or (2) In monthly payments over a two-year period which payments shall also carry interest at the (Interlocal Cooperative Agreement, cont....) 5 statutory rate for judgments, pursuant to Texas law. 5. This Jurisdiction accepts no financial responsibility or commitment for its membership in the Authority except for costs of furnishing a mechanism for transferring 911 callers requesting medical assistance from this Jurisdiction's 911 center to Authority's designated EMS control center, and that referred to in Paragraph 11(b), below. The sole requirements for membership in the Authority are: (a) Except for the Tarrant County Fire District, this Jurisdiction agrees to adopt and enforce the Uniform EMS Ordinance, which is attached hereto, and incorporated by reference herein (and marked Exhibit A); (b) This Jurisdiction agrees to establish and participate in the Authority's first responder program no later than August 1, 1989, as provided for in the Uniform Ordinance and regulated by EPAB, and to fund first responder operations within this Jurisdiction; provided, however, that the Authority's ambulance service contractor shall provide initial and continuing first responder training without charge to this Jurisdiction, and provided further that, at this Jurisdiction's option, required first responder medical and communications equipment may be financed and purchased by the Authority and paid for by way of an increase in the subsidy or price level applicable in this Jurisdiction. (c) Approval of the Uniform Schedule of Price/Subsidy Options Effective August 1, 1988 -- December 31, 1989; (d) Selection by this Jurisdiction of one option from the Uniform Schedule of Price/Subsidy Options Effective August 1, 1988 -- December 31, 1989; (e) Thereafter, this Jurisdiction agrees that, no later than July 31 of each year, it will annually select, approve and adopt from the Authority's annually revised Uniform (Interlocal Cooperative Agreement, cont....) 6 Schedule of Price/Subsidy Options a price/subsidy formula to be effective in this Jurisdiction. Prices selected on July 31 shall then become effective on the following January 1, and the selected subsidy level shall become effective on the following August 1. (f) Any member jurisdiction which subsidized ambulance services during fiscal year 1987-1988, shall agree to subsidize the Authority in an amount not less than 90% of that member jurisdiction's EMS subsidy in fiscal year 1987-1988 during the Authority's first year of operations, beginning Aug. 1, 1988. Until such time as the Authority has accumulated a prudent net worth as defined in Paragraph 10(b), below, such annual level of subsidy shall not be decreased by more than 10% of the fiscal year 1987-1988 amount during any single year. Such subsidy contributions shall be made, quarterly, in advance, to the Authority beginning with the quarter starting August 1, 1988. For purposes of this provision, subsidies paid for first responder services shall not be counted as subsidy. The first year subsidy to the Authority by the City of Fort Worth shall, pursuant to this provision, be $1,359,269, of which $170,982 shall be paid in the form of accumulated equity in the Fort Worth ambulance facility, ownership of which facility shall be transferred and conveyed to the Authority effective August 1, 1988, subject to a mutually acceptable installment note at eight (8) percent interest for the unpaid balance of $510,376, financed over a twelve year period. Thus, Fort Worth's first quarter subsidy payment shall be one-fourth of $1,188,287, or $297,071.75, due August 1, 1988. At such time as the Authority's prudent net worth level has been achieved as defined in Paragraph 10(b), hereof, no restrictions regarding subsidy reductions shall apply. (g) The above restriction on subsidy reduction not withstanding, if the subsidy/price structure effective in any member jurisdiction during fiscal year 1987-1988 was in excess of an applicable combination shown on the Uniform Schedule of Price/Subsidy Options Effective (Interlocal Cooperative Agreement, cont....) 7 August 1, 1980 -- December 31, 1989, that jurisdiction may upon becoming a member of the Authority reduce its initial subsidy/price balance to any level shown on the Uniform Schedule. Thereafter, the restriction on rate of subsidy reduction specified in Paragraph (f), immediately above, shall apply. (h) Should any member jurisdiction fail to maintain substantial compliance with any membership require- ment specified herein, the Authority's Board of Directors may, at its option and after written notice to that jurisdiction and reasonable opportunity to correct the deficiency, disqualify that jurisdiction from membership in the Authority and revoke its membership status. In such event, the removed jurisdiction shall not be eligible for distribution of any share of the Authority's then- current Capital Account. 6. The Authority shall have all of the powers allowed or provided by Art. 4413(32c), Texas Civil Statutes, the "Interlocal Cooperation Act." 7. The Authority shall not itself operate the ambulance service, except in the event of default by the Authority's competitively selected provider ("Contractor"). In the event of such a default by the Contractor, the Authority may operate the ambulance system for a period not to exceed 18 months, during which time the Authority shall again conduct a competitive Request for Proposal process for the award of a contract to another provider. 8. The business structure of the emergency medical system to be created by this Agreement, shall be what is known as the "Public Utility Model," enhanced by the addition of the "Three- Way Leasing Program." In this regard, items to be transferred from the City of Fort Worth to the Authority, effective not later than August 1, 1988, and subject to mutually acceptable transfer agreements, shall include: (a) The Medstar trade name and provider license; (Interlocal Cooperative Agreement, cont....) 8 (b) The EMS communications system, related Motorola lease, communications system maintenance agreement, and tower rental agreements; (c) The Medstar telephone numbers and lines; (d) The Texas Lifeline Corporation contract for ambu- lance services, renegotiated and extended in accordance with the terms and conditions set forth in Exhibit C, "Memorandum of Understanding"; (e) The Medstar post office box and "lock box" banking arrangements, restructured to accommodate the public utility model business structure established hereby; (f) Fort Worth's rights and obligations pursuant to the "three-way leasing program" currently in effect, renegotiated as appropriate to effect improvements in EMS facilities and infrastructure necessary to safe regional expansion of the Medstar service area; (g) Medstar's third party payor agreements, including any existing Medstar contracts for interfacility transports; and, (h) Such miscellaneous items used in the Medstar operation as may be mutually agreeq to by the parties. (i) After said transfer, the Authority shall be solely responsible for related costs, debts, improvements, and other expenses associated with these items. All agreements affecting transfer of said items shall be so structured as to: (1) Cause no increase in the financial liability of the City of Fort Worth as a consequence of these transactions; cinteriocal cooperative Agreement, cont....) 9 (2) Provide reasonable protection to the City of Fort Worth in the event of default by the Authority on obligations affecting the contingent liability of the City of Fort Worth or the operation of the Medstar system within the City of Fort Worth; and, (3) Provide for release of the City of Fort Worth from contingent liability for the Authority's financial obligations as soon as the Authority has established sufficient financial stability to effect such release. 9. The Authority shall have the following duties and powers: (a) To set response time standards for all areas of each member jurisdiction. (b) To provide each member jurisdiction with advanced life support ambulance service, such service to comply with all applicable state laws and rules, as well as all rules, regulations, and clinical standards as the Medical Control Board may from time to time promulgate. (c) After expiration of the contract for ambulance services transferred to the Authority by the City of Fort Worth as provided for in Paragraph 8, above, to provide such ambulance service by the competitive award of a contract by way of a Request for Proposal process. Such competitive Request for Proposals shall be conducted for the selection of a Contractor no less frequently than every 11 years. The contract awarded to the contractor shall require the contractor to provide all ambulance services in each member jurisdiction, except for those exempted in Section 6F of the Uniform EMS Ordinance (Exhibit A) adopted concurrently herewith. (d) To prepare and distribute, not later than June 30 of each year to each member jurisdiction a schedule of price/subsidy options, called the Uniform Schedule of (Interlocal Cooperative Agreement, cont....) 10 Price/Subsidy Options, which shall range ffom zero-level subsidy with full cost user-fees, to zero-level user fees with full-cost annual per capita subsidies. (The Uniform Schedule of Price/Subsidy Options Effective August 1, 1988 -- December 31, 1989 is attached hereto as Exhibit D.) Future Price/Subsidy Option Schedules shall be prepared in the same general format as Exhibit D to this Agreement. (e) Each member jurisdiction shall, no later than July 31 of each year notify the Authority of that member's selection of a price/subsidy formula from the Uniform Schedule of Price/Subsidy Options received by the jurisdiction from the Authority. The Authority shall set the rate schedule for each member jurisdiction according to that member's decision, effective the following January 1, and the newly selected level of subsidy shall be effective the following August 1. (These effective dates are offset by seven months to allow adequate time to compensate for the substantial fee-for-service collection lag which prevails in the prehospital care industry.) (f) The Authority shall implement an ambulance service subscription program unless otherwise prohibited by law. That program shall be a contract which allQws a resident, and members of the resident's household of any member jurisdiction to annually purchase and prepay all uninsured portions of medically necessary ambulance service. (g) To purchase, lease, acquire, accept, own or hold real or personal property, to operate or maintain same, to borrow or incur debt in its own name, to accept gifts, grants or bequests, to insure itself and its members for any liabilities which might be incurred through performance of this Agreement, to contract in its own name, and to sue or be sued in its own name. 10. To fund the Authority's required operations, and to insure use of sound business controls and financial management unteriocai cooperative Agreement, cont....) 11 practices in the Authority's day-to-day operations, the following financial requirements shall be met and maintained. (a) The Authority shall adopt sound business practices and accounting methods, appropriate to a governmental Enterprise Fund operation. (b) The Authority shall establish and maintain a prudent net worth, which shall mean an amount of money not less than $5,000,000, or 50% of the Authority's annual budget, whichever is greater. Such net worth shall be recorded on the books of the Authority in an account called the Capital Account, and each member jurisdiction's pro-rata share of the Capital Account shall be calculated at least once every fiscal year. Each members' pro-rata share of the Capital Account shall be based upon the population of each member city as reported by the United States Census Bureau, compared to the total population of all member jurisdictions, as reported by the United States Census Bureau. (c) The Authority shall operate on a fiscal year, which shall begin on October 1 and end on September 30 of each year. (d) The Authority shall cause to be developed and implemented a long range financial management plan designed to ensure long-range financial stability. (e) Until such time as the Authority has established a prudent net worth, the Authority's Uniform Schedule of Price/Subsidy Options shall automatically be adjusted in conformance with the Medical Consumer Price Index for the most recent twelve month period for Which such data are then available, not to exceed a 12 percent increase in any single year. After that prudent net worth level has been achieved, all future Uniform Schedules of Price/Subsidy Options shall be revised as necessary to maintain but not exceed a prudent net worth as defined (Interlocal Cooperative Agreement, cont....) 12 herein, not to exceed a 12 percent increase in ambulance service fees in any single year. (f) At such time as the Authority's prudent net worth level has been achieved, member jurisdictions may apply such population-based discounts as may then be available as described in Exhibit C, "Memorandum of Under- standing", hereof, in any of the following ways: (1) To reduce rates or subsidies in that jurisdiction; or, (2) To reduce the subscription program fee charged in that jurisdiction, or (3) To recover costs incurred prior to August 1, 1988 in the development and implementation of this EMS system; or (4) A combination of (1), (2), or (3), above. (g) The Authority shall {hake provision for an annual audit of the Authority by an independent certified public accountant. (h) Any decision by the Authority affecting the financial obligations, contingent or other, of a member jurisdiction shall be subject to prior-approval by the affected member jurisdiction. 11. Subject to the provisions of Paragraph 2, above, this Jurisdiction may withdraw from membership in the Authority. Should this Jurisdiction withdraw as a member, for any reason except that listed below in Subparagraph (c) of this Section, this Jurisdiction: (a) Forfeits all rights, title, interest or claim to any asset, or combination of assets of the Capital Account of the Authority; (Interlocal Cooperative Agreement, cont....) 13 (b) Commits itself to pay to the Authority any unamortiz ed infrastructure costs attributable to this Jurisdiction or unpaid costs of first responder equipment financed by the Authority which are carried on the books of the Authority, and which were originally approved by this jurisdiction. (c) In the event any member jurisdiction experiences repeated and chronic failure of the Authority, or the Authority's Contractor, to comply with the response time standards established for that member jurisdiction, and after written notice to the Authority and reasonable opportunity to correct such deficiencies, that member jurisdiction may withdraw subject to the following terms: (1) The member jurisdiction must give written notice to the Authority that the member intends to invoke this section of this Agreement; (2) Upon a continued failure for the following three full months after receipt by the Authority of the written notice described in (c) (1) above, the member jurisdiction may withdraw as a member, by giving written notice to the Authority, to be effective ten (10) days after receipt of such notice by the Authority. (3) Upon the effective date of the withdrawal, the Authority shall cease ambulance service to the former member jurisdiction, and within one hundred eight (180) days the Authority shall remit in full to the former member its per capita share of the Authority's Capital Account, as defined in Paragraph 10(b) above, as of the last fiscal year, less any unamortized capital costs and unpaid first responder equipment owed by the former member jurisdiction, as defined in Paragraph 11(b) above. 12. Until such time as the total population of all member jurisdictions of the Authority exceeds 880,000 persons, the (Interlocal Cooperative Agreement, cont....) 14 membership of the Board of Directors shall be appointed in the following manner: (a) The Medical Director of the Emergency Physicians Advisory Board shall be a member of the Board of Directors, ex officio, but with full voting rights; (b) The City of Fort Worth shall appoint four (4) directors, whose collective expertise shall fulfill at least three of the criteria described in Paragraph 3, (a)-(d), above, and each of whom meet at least one of those listed criteria. Immediately upon adoption of the Uniform EMS Ordinance and this Interlocal Cooperative Agree- ment by the City of Fort Vorth, and upon appointment by Fort Worth of its Directors to the Authority, the Board of Directors of the Authority shall proceed with the process of implementing ambulance services, with a target startup date of August 1, 1988. (c) Should the City of Arlington choose to join, Arlington may appoint two (2) members qualified to be members, each of whom meet at least one of the criteria described in Paragraph 3, (a)-(d), above, provided, however, that not more than two members meeting each of those listed criteria may simultaneously sit on the Authority's Board. (d) All other member jurisdictions of the Authority combined shall be entitled to one (1) seat on the Board of Directors for each 110,000 persons residing within all other member jurisdictions combined, but no less than one (1) member in any event. All members of the Board selected by jurisdictions other than Fort Worth and Arlington shall be chosen as follows: (1) Each member jurisdiction shall be entitled to appoint one (1) member to a selection Committee, Voting on the Selection Committee shall be on a one vote per jurisdiction basis. (Interlocal Cooperative Agreement, cont....) 15 (2) No later than July 21, 1988, the Selection Committee shall, for each position for which an appointment shall be made, compile a list of not more than three (3) persons, each of which is eligible and possesses an area of expertise which has not been filled by two prior appointments by Fort Worth and, if a member, Arlington. Each list of nominees for each available position shall be called the "Candidates List," and all nominees on each such Candidates List shall possess the same area of expertise. (3) The Candidates' Lists shall be submitted no later than July 22, 1988 to the City Council of each member of the Authority, with the exception of Fort Worth and Arlington. If Rural Fire Protection District Number One of Tarrant County is also a member of the Authority, the Candidates Lists shall also be presented to the Board of that District. (4) Each member jurisdiction shall cast all of its votes for one (1) of the eligible candidates on the candidates' list. Each member jurisdiction shall be entitled to the number of votes which corresponds to the number of residents residing in that member jurisdiction, as announced by the most recent United States Census Bureau Statistics. For purposes of this provision, the population of Rural Fire District Number One shall include the estimated population of the unincorporated areas of Tarrant County. . (5) The candidate for each available position receiving the most votes shall be certified as the winner of the election to that seat. The Selection Committee shall forward the certified results of the first election to the existing Board Members appointed by Fort Worth (and Arlington, if a member). Those Board members shall receive and certify the results causing the elected persons to kinieriocai cooperative Agreement, cont....) 16 become members of the Board. Thereafter, the Selection Committee shall forward the results of all elections of the Board to the other Board members of the Authority. Those Board members shall receive and certify the results causing the elected persons to become members of the Board. 13. At such time as the total population of all member jurisdictions exceeds 880,000 residents, as reported by the U.S. Census Bureau, the following methods shall apply to select members of the Board: (a) The total population of all member jurisdictions shall be divided by eight (8), the number of appointed seats on the Board; (b) Fort Worth and Arlington may each appoint one (1) member for each 1/8th of the total population which the respective population of those two cities represents, provided such appointees meet the eligibility require- ments for residency and type of expertise as set forth in Paragraph 12, above, and provided that no more than two members possessing the same expertise may sit on the Board simultaneously. There shall be no represen- tation for fractional population; that is, for a Board membership a full 1/8 of the total is required. (c) All other member jurisdictions shall elect Board members in the manner described in Paragraph 12(c), above, except that instead of one Board member for each 110,000 population the other member jurisdictions may appoint one Board member for each 1/8 of the then- current population of all member jurisdictions, and provided that no more than two menlbers possessing the same expertise may sit on the Board simultaneously. 14. Because the Authority's ability to deliver services to certain jurisdictions will depend, in part, upon whether certain other jurisdictions elect to become members of the Authority, the following sequence of decision-making shall apply: (Interlocal Cooperative Agreement, cont....) 17 (a) First-Round Membership: The jurisdictions listed in Exhibit B, "Jurisdictions Eligible for First-Round Membership" shall be eligible to receive the respective levels of response time performance shown in Exhibit B, regardless of decisions on membership made by other jurisdictions. Thus, the jurisdictions listed in Exhibit B are eligible for "first-round" membership until May 31 , 1988. (b) Second-Round Membership: All other jurisdictions (i.e., those not listed in Exhibit B) shall be eligible for "second round" membership. No later than June 15, 1988, all other interested jurisdictions which request such information shall be informed of the level of service which will be offered by the Authority to each respective "second-round" jurisdiction, and those jurisdictions shall be eligible for "second-round" membership until July 15, 1988. (c) The provisions of Paragraphs (a) and (b) immediately above notwithstanding, each jurisdiction in Tarrant County shall be offered a combined level of service and a subsidy/price balance which is equal to or better than that which was enjoyed by that same jurisdiction immediately prior to consideration of membership. For purposes of this provision, temporary interim Medstar coverage agreements shall not apply. (d) After the closing of these "first-round" and "second- round" opportunities for membership, opportunity for membership in the Authority shall be annually available, subject to applicable provisions of this Agreement and approval by the Authority. 15. The Authority is expressly prohibited from furnishing service to any area which is not a member of the Authority, except for service pursuant to a mutual aid agreement approved by the Authority, or emergency coverage of non- member jurisdictions not to exceed sixty (60) days in duration. (Interlocal Cooperative Agreement, cont....) 18 16. Texas Lifeline Corporation shall not be prohibited from completing already-existing contracts for service with jurisdictions which are not members of the Authority. However, effective August 1, 1988, only member jurisdictions shall be rendered service under the Medstar trade name, except for authorized mutual aid service. Infrastructure and support services used by Texas Lifeline Corporation in performance of Authority's ambulance service contract shall not be employed in the rendering of services to nonmember jurisdictions without the expressed written permission of the Authority, and subject to a payment acceptable to the Authority for such use of such facilities in rendering such outside services. 17. All temporary Medstar contracts for ambulance services currently in existence shall be automatically extended through July 31, 1988, and then shall automatically terminate. LIST OF EXHIBITS Exhibit A. Uniform EMS Ordinance Exhibit B. Jurisdictions Eligible for First-Round Membership Exhibit C. Memorandum of Understanding Exhibit p. Uniform Schedule of Price/Subsidy Options Effective August 1, 1988 -- December 31, 1989 APPROVAL Approved by the City Council of woRrN , Texas, this t aT)� day of APRIL 1988. C I T4MAG EXHIBIT A. UNIFORM EMS ORDINANCE Be it ordained by the City Council of Texas: SEC. 1 STATUTORY AUTHORITY. This Ordinance is enacted by the City Council of — Texas, pursuant to Sec. 3.10, Art. J447o Texas Civil Statutes, which provides that local governmental units may establish standards for ambulances, and to Sec. 4(a), Art. 4413(32c) Texas Civil Statutes which provides that combinations of local governmental units may contract for the provision of governmental services. SEC. 2 GENERAL PURPOSES AND INTENT OF ORDINANCE. It is the purpose of this Ordinance: A. To establish a regulated ambulance service system which can provide state-of-the-art clinical quality of care, with reasonable, reliable response time standards, and with the goal of furnishing the best possible chance of survival, without disability or preventable complication, to each ambulance patient. B. To establish a sole-provider ambulance system, because it is unreasonable to have unnecessarily high rates and/or public subsidy to make needed improvements to ambulance service in the Service Area, when a more efficiently designed system can achieve the same results at lower cost. The most efficient design to achieve the goals of high-quality service, at the lowest cost, consistent with the quality of care required, is the implementation of the system described herein. (Exhibit A. Uniform EMS Ordinance, cont....) 2 C. To provide more effective system performance through the provision of services by a competitively selected qualified private operator, rather than direct government4l operation of ambulance services. D. To provide more effective medical control by establishing a multi-jurisdictional Emergency Physicians Advisory Board (EPAB) and by empowering that Board to oversee and regulate all clinical aspects of the emergency medical system which affect patient care. SEC. 3 DEFINITIONS. For the purposes of this chapter, the following words and phrases shall have the meanings respectively ascribed to them by this section: A. Advanced Life Support Ambulance. Any vehicle which is equipped to provide treatment of life-threatening emergencies through the use of advanced airway management, intravenous therapy, and other advanced prehospital care procedures, and which is equipped to transport sick or injured persons to or from health care facilities. B. Approved Rate Schedule. Those fees for ambulance services rendered which have been established for this Jurisdiction by the Ambulance Authority from the Uniform Schedule of Price/Subsidy Options. C. Area Metropolitan Ambulance Authority ("Ambulance Authority"). That public administrative agency established to oversee the operation of the ambulance system established by this Ordinance. D. Base Station Physician. A physician licensed to practice medicine in the State of Texas, knowledgeable in the (Exhibit A. Uniform EMS Ordinance, cont....) 3 prehospital emergency medical protocols, EMS radio procedure and the general operating policies of the ambulance system, and a person from whom ambulance persopnel may take medical direction by radio or other remote com- munications device. E. Contractor. That person selected by the Ambulance Authority, pursuant to the Request for Proposal process, which is awarded the right to provide all ambulance services in this Jurisdiction, except those specifically exempted by Section 6F of this Ordinance. F. Emergency Medical Technician (EMT). An individual who is a "specially skilled emergency medical technician" under Sec. 1.03 (10) of Art. 4447o, Texas Civil Statutes. G. EMS Control Center or Control Center. The single facility designated by the Ambulance Authority as the central communications center from which all ambulances operating in the Service Area shall be dispatched and controlled. H. Emergency Physicians Advisory Board ("EPAB"). The medical board created by this Ordinance and empowered to promulgate the various standards, rules and regulations related to clinical aspects of ambulance service and first responder services within the Service Area, and to perform medical audits and otherwise monitor system performance. I. First Responder. Any person, fire department vehicle, police vehicle, or other vehicle not normally used for purposes of patient transport, but which vehicle and on-board personnel are capable of providing first responder services in medical emergencies. J. Helicopter Rescue Unit. Any rotary wing aircraft providing basic or advanced life support services and patient trxnl�ic A. unitorm bm5 Urdinance, cont....) 4 transportation originating from the scene of emergency incidents which occur within the Service Area. K. Interlocal Cooperative Agreement ("Agreement"). That contract adopted by this jurisdiction concurrently with the passage of this Ordinance, which contract is entered into by this Jurisdiction pursuant to Art. 4413(32c) Texas Civil Statutes more commonly known as the "Interlocal Cooperation Act." L. Medical Audit. An official inquiry into the circumstances involving an ambulance run or request for ambulance service, conducted by the Medical Director or a licensed physician designated by the Medical Director. M. Medical Control. Direction given ambulance personnel by a base station physician through direct voice contact, with or without vital sign telemetry, as required by applicable medical protocols promulgated by the EPAB, and by Sec. 10.3(19), Art. 44470, Texas Civil Statutes. N. Medical Director. The licensed physician appointed by the EPAB serving as administrative officer in carrying out the duties and powers of the EPAB. O. Medical Protocol. Any diagnosis-specific or problem- oriented written statement of standard procedure, or algorithm, promulgated by the EPAB as the normal standard of prehospital care for a given clinical condition. P. Mutual Aid Agreement. A written agreement between the Ambulance Authority and one or more entities whereby the signing parties agree to provide backup ambulance service to one another under conditions and pursuant to terms specified in the agreement as approved by the Ambulance Authority. (Exhibit,A. Uniform EMS Ordinance, cont....). 5 Q. Paramedic. A person qualified as a certified "paramedic emergency medical technician" as defined by Sec. 1.03(11) of Art. 4447o, Texas Civil Statutes. R. Patient. An individual who is ill, sick, injured, wounded or otherwise incapacitated and is in need of or is at risk of needing medical care during transport to or from a health care facility. S. Person. Any individual, firm, association, partnership, corporation, governmental entity, or other group or combination acting as a unit. T. Response Time. The actual elapsed time between receipt of notification at the EMS Control Center that an ambulance is needed at a location within the Service Area and the actual arrival of an ambulance at that location. U. Senior Paramedic in Charge. That person among the certified personnel assigned to an ambulance, not the driver, who is a certified paramedic designated as the individual in command of the ambulance. V. Service Area. That geographic area which is contained within the boundaries of all of the jurisdictions which adopt this Uniform EMS Ordinance, and which adopt and execute the Interlocal Cooperation Agreement implementing the Ordinance, thereby becoming members of the Ambulance Authority. W. Special Event. Any public event located within the Service Area, for which standby ambulance service is arranged in advance, and for which an ambulance (or ambulances) are hired by the sponsor of the event or other interested party. X. Specialized Mobile Intensive Care Unit. A vehicle which is specially constructed, equipped, staffed, and employed in the (Exhibit A. Uniform EMS Ordinance, cont....) 6 interfacility transport of patients whose requirements for enroute medical support are likely to exceed the clinical capabilities of an advanced life support ambulance. SEC. 4 EMERGENCY PHYSICIANS ADvISORY BOARD (EPAB). There is hereby created an Emergency Physicians Advisory Board which shall oversee and regulate on behalf of this city all medical aspects of the ambulance system which affect patient care. A. The EPAB shall consist of a board whose membership shall be composed as follows: (1) The medical director, or his designee, of each hospital emergency department which is located within the Service Area and which maintains an emergency medical services department staffed twenty-four (24) hours per day, seven (7) days per week by in-house physicians; all EPAB members shall be licensed physicians, preferably engaged in the full-time practice of emergency medicine; and, (2) Five (5) additional licensed physicians with active specialties or sub-specialties of benefit in developing standards for emergency prehospital care, and who are appointed by and serve at the pleasure of the Tarrant County Medical Society. (3) The EPAB may, at its option, elect from among its members an Executive Board consisting of not less than seven nor more than nine physicians, which Executive Board shall exercise such powers and duties of EPAB as are set forth in written by-laws approved by a two-thirds majority vote of the entire EPAB membership. (Exhibit A. Uniform EMS Ordinance, cont....) 7 B. The EPAB shall appoint a Medical Director who shall be responsible for the day-to-day affairs of the EPAB in carrying out its duties under this Ordinance. The Medical Director shall be a licensed physician who is board-certified in emergency medicine. The Medical Director shall serve at the pleasure of EPAB. C. The EPAB shall have the following powers and duties: (1) To recommend to the Ambulance Authority medically appropriate response time standards for this Jurisdiction; (2) To establish standards for patient care, including standards for ambulance and first responder vehicles and on-board equipment; (3) To develop medical protocols for ambulance and first responder services and periodically revise same; (4) To develop control center protocols and periodically revise same; (5) To conduct medical audits and develop standards and procedures for the conduct of such audits; (6) To develop and periodically revise and administer both written and practical tests for the certification and licensing of emergency medical services personnel, including ambulance personnel, first responders, and EMS control center personnel; (7) To develop and periodically revise and administer educational material, programs and/or tests to insure that base station physicians are knowledgeable of the local ambulance system, its medical protocols, radio (Exhibit A. Uniform EMS Ordinance, cont....) procedures, and transport protocols; and to certify qualified physicians as base station physicians; (8) To conduct inspections of vehicles, equipment and supplies on both an announced and unannounced basis; (9) To monitor response time performance; in this regard, the Ambulance Authority shall furnish such statistical information regarding response time performance as may be requested by EPAB; (10) To develop standards and procedures for the resolution of disputes regarding the application of exemptions from late run penalties assessed against the ambulance service contractor for failure to meet response time standards; (11) To periodically conduct intensive reviews of the system's performance relative to specific clinical types and to revise medical protocols and such other standards of the system as may be appropriate in light of the findings; (12) To conduct medical audits of individual cases as requested by the Ambulance Authority, by any elected official of a member jurisdiction, by any licensed physician regarding a patient of such physician, or by any paramedic involved in the"case which is the subject of the audit request; (13) To annually present a written and oral report to the Ambulance Authority concerning the state of clinical performance of the ambulance system; each member jurisdiction shall be informed of the time and place of such oral report at least 30 days in advance of that (Exhibit A. Uniform EMS Ordinance,cont....) 9 meeting and shall be invited to send representatives, and shall be furnished a copy of the written report; (14) To establish such committees as may be necessary to aid in the performance of its powers and duties; (15) To approve standards governing the operation of specialized mobile intensive care units, including standards limiting the types of patients which may be transported thereby, and to issue, suspend, revoke, and renew permits for the operation of such units as required by this Ordinance; (16) To approve standards governing the operation of helicopter rescue units, including standards defining the circumstances under which such units may be deployed to emergency scenes, and to issue, suspend, revoke, and renew permits for the operation of such units as required by this Ordinance; and, (17) To approve standards governing the operation of point-to-point wheelchair transport units, including standards limiting the types of patients which may be transported thereby, and to issue, suspend, revoke, and renew permits for the operation of such units as required by this Ordinance. D.- For each patient transported by the Ambulance Authority or its contractor, and for each patient transported by other providers issued permits pursuant to this Ordinance, the transporting provider shall pay to EPAB a fee of three dollars ($3.00), which sum shall be used to defray the costs of medical regulation of the EMS system. Such payments shall be made monthly by the fifteenth (15th) day of each month for services rendered during the previous calendar month. Such funds shall be maintained in a separate account administered by the (Exhibit A. Uniform EMS Ordinance,cont....) 10 Ambulance Authority on EPAB's behalf, and shall be expended solely for the purposes set forth in this Sec. 4 as' approved by EPAB or its Executive Board. Effective August 1, 1990, this per-transport fee shall be automatically increased to four dollars ($4.00) per patient transported, and may thereafter be periodically increased at the discretion of EPAB, subject to approval by the Ambulance Authority, but not more often than annually, and no single increase may exceed five percent (5%). E. Effective August 1, 1988, funds then remaining in the account of the Emergency Physicians Advisory Board of the City of Fort Worth shall be automatically transferred to the EPAB account established and maintained by the Ambulance Authority. F. This Jurisdiction shall indemnify and hold harmless EPAB, its members, its Medical Director, and EPAB staff members from liability for actual damage, including costs and attorney's fees, arising from any claim, lawsuit, or judgement resulting from an act or omission of said EPAB member, the Medical Director, or EPAB staff member while acting in the scope and course of his office, provided that such liability arises out of or in connection with the provision of ambulance services or first responder services originating within the corporate limits of this Jurisdiction. SEC. 5 AREA METROPOLITAN AMBULANCE AUTHORITY. By adopting this Ordinance, and concurrently therewith executing and approving the Interlocal Cooperative Agreement, there is hereby established an Area Metropolitan Ambulance Authority, which is herein called the "Ambulance Authority;" and in regard to that Ambulance Authority the following shall apply: A. The Ambulance Authority is hereby designated as the sole provider of all ambulance services within this Jurisdiction, (Exhibit A. Uniform EMS Ordinance,cont....) 11 pursuant to the terms, conditions and provisions of the Interlocal Cooperative Agreement, except for those services exempted by Sec. �F, below. B. The Ambulance Authority shall comply with all terms of the Interlocal Cooperative Agreement, and have all of the duties, powers and responsibilities enumerated therein. C. The Ambulance Authority is required to provide this Jurisdiction with advanced life support ambulance service. Such service shall comply with all applicable state laws and rules, as well as all rules, regulations, standards and response times as the Ambulance Authority or EPAB may from time to time promulgate. D. After termination of the current competitively-awarded contract between the City of Fort Worth and Texas Lifeline Corporation, which amended contract shall be assigned to the Ambulance Authority effective August 1, 1988, and any extensions thereof, the Ambulance Authority shall provide such ambulance service by the award of a contract to a qualified provider after a competitive bid process. However, compliance with response time and quality of care standards are the non-delegable duty of the Ambulance Authority. SEC. 6 VIOLATIONS. It shall be unlawful: A. To perform duties as an ambulance driver, attendant (EMT or paramedic), or EMS dispatcher without a current certification issued by the EPAB; B. To permit a person to work as an ambulance driver, attendant or EMS dispatcher without a current license issued by the EPAB; <►• Uiu,wttt mviz)vrainance,cont....) t2 C. To use, or cause to be used any ambulance service other than that of the contractor authorized to operate in this Jurisdiction by virtue of its contract with the Ambulance Authority, except those services described in Paragraph F of this Section 6. D. For any person, firm or organization to provide ambulance service within this Jurisdiction, other than the contractor which contracts with the Ambulance Authority; or to provide point- to-point wheelchair transport services to or from health care facilities, helicopter rescue services, or specialized mobile intensive care services except in accordance with EPAB regulations governing the delivery of such services, and then only pursuant to a permit issued by EPAB for the operation of such units; or after August 1, 1989 to provide first responder services without a first responder permit issued by EPAB. All such special permits when issued by EPAB shall be valid for a period of two (2) years, and then shall be subject to provisions governing renewal, such provisions to be developed by EPAB. Holders of such permits shah comply with requirements for payment of permit fees as set forth in Section 4D, hereof. E. To knowingly give false information to induce the dispatch of an ambulance or helicopter rescue unit. F. It shall be a defense to any alleged violation of this Section 6 that the vehicle is being used solely in any of the following manners: (1) A privately owned vehicle not ordinarily used in the business of transporting persons who are sick, injured, wounded, incapacitated or helpless. (2) A vehicle rendering service as an ambulance in the event of a major catastrophe or extreme system overload (Exhibit A, Uniform EMS Ordinance, cont....) 13 when such condition is declared by the Medical Director, the Executive Director of the Ambulance Authority, or by an authorized representative of the Ambulance Authority's contracted ambulance service provider, and such assistance has been requested by the Control Center. (3) Any ambulance owned or operated by the federal or state government. (4) Any transport to a location within the Service Area, which transport originated from a point outside the Service Area. (5) Mutual aid calls when rendered pursuant to a mutual aid agreement approved by the Ambulance Authority. (6) Special events coverage, so long as such service is provided without charge by an emergency medical services volunteer provider, as defined in Sec. 1.03(18), Art. 44470, Texas Civil Statutes. (7) Wheelchair transport services which are not provided on a point-to-point basis, but which provide pickup and delivery by way of regularly scheduled routes. (8) Medical transports by helicopter where such transports originate outside the Service Area or at a hospital location within the Service Area. (9) Point-to-point wheelchair transport services rendered by not-for-profit organizations. (Exhibit A. Uniform EMS Ordinance, cont....) 14 SEC. 7 PENALTIES. The following prqvisions for application of penalties for violation of this Ordinance shall apply: A. Any person convicted of violating the provisions of this Ordinance shall be fined no more than five hundred dollars ($500.00). This does not serve to limit any other remedies available to this Jurisdiction in law or equity. B. Each day that any violation of this article is committed or permitted to continue shall constitute a separate offense. SEC. 8 TRAFFIC LAWS; EXEMPTION. When the driver of an ambulance has reasonable grounds to believe that an emergency exists, as determined by the EMS control center, the driver of the ambulance may: A. Park or stand, irrespective of the otherwise applicable provisions of law, ordinance or regulations; B. Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation; C. Exceed the maximum speed limits permitted by law, ordinance or regulation; provided, however, that life and property are not endangered thereby; D. Disregard laws, ordinances and regulations governing directions or movements or turning in specified directions. E. Provided, however, that any exemption herein granted shall apply only when such ambulance is operating with siren and emergency lights in operation, and when such audible and visual signals mVet the requirements of law, ordinance or regulation; and provided further, that the foregoing provisions (Exhibit A. Uniform EMS Qrdinance, cont....) 15 shall not operate to Telieve the driver of any ambulance from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others. Exh'I i . Jurisdictions Eligible For First Round Membership Urban Sub-Urban Urban Sub-Urban Contiguous Contiguous Non-Contiguous Non-Contiguous Stan(Lard Stanch Yi Standar StaWard Priority 1 (8 min, 90% (10 min, 90% (10 min, 80% (12 min, 80 o Priority 2 10 min, 90%) 12 min, 90%) 12 min, 80%) 14 min, 80%) S�1Y Fort Worth Arlington Westworth Village Westover Hills River Oaks t_.__. White Settlement Sansom Park Lake Worth Saginaw ,f Blue Mound Watauga Keller ,f Haltom City Richland Hills North Richland Hills urst * Bedford * ,� Euless * Colleyville * ,j Grapevine Grand Prairie Pantego Dalworthington Gardens Mansfield Forest Hill Kennedale Everman ,f Crowley Edgecliff Village Burleson Benbrook * The standards listed are reflective of the current response time standards existing in or available to these communities. Should participation be such that any of these cities become operationally non-contiguous, the response time standard would change accordingly (see pages 2 and 3). 1 River Oaks'contract expiring June 30, 1988 provides for a 6 minute response time with 90% reliability. An extension from July 1 through July 31 will be offered at the Urban, Contiguous standard which would, therefore, also be the offer under the new system. Note: Unincorporated areas surrounding member jurisdictions will be covered at the rural standard of 15 minutes, with 70% reliability. Exhibit B, Page l Factors Which Could Cause Cities To I lave Reduced Standard The chart on the preceding page listed the proposed standard for member jurisdictions. It was assumed that all cities presently under contract (excluding temporary, interim contracts) would be participating. It is possible that some cities could have different response time commitments, for the standard price/subsidy combination, if no neighboring jurisdictions participate making that city operationally non-contiguous. Following is a list of potentially affected cities: 1.) Blue Mound would go from a Suburban, Contiguous standard to a Suburban, Non-Contiguous standard if none of the following jurisdictions participated: Saginaw 2.) North Richland Hills would go from an Urban, Contiguous standard to an Urban, Non-Contiguous standard if none of the following jurisdictions participated: Haltom City Hurst Richland Hills Watauga 3.) Hurst would go from an Urban, Contiguous standard to an Urban, Non-Contiguous standard if none of the following jurisdictions participated: Euless Bedford North Richland Hills Richland Hills Colleyville 4.) Bedford would go from an Urban, Contiguous standard to an Urban, Non-Contiguous standard if none of the following jurisdictions participated: Euless Hurst Colleyville 5.) Euless would go from an Urban, Contiguous standard to an Urban, Non-Contiguous standard if none of the following jurisdictions participated: Hurst Bedford Colleyville Grapevine 6.) Colleyville would go from a Suburban, Contiguous standard to a Suburban, Non-Contiguous standard if none of the following jurisdictions participated: Hurst Euless Bedford Grapevine Generally the population density standards are (total population is also considered): Urban Greater than 1500 people per square mile Suburban Between 800 and 1500 people per square mile Rural Less than 800 people per square mile Exhibit B, Page 2 on i > > Non- _ontigu us ProritV Time Reliability Priority Time Reliability 1* $ min 90% 1° 10 min 80% 2° 10 min 90% 2° 12 min 80% 3°,4°,5° 60 min 90% 3°,4°,5° 90 min 80% Priority Time Reliability Noijjy Time Reliability 1° 10 min 90% 1° 12 min 80% L 2° 12 min 90% 2° 14 min 80% 3°,4°,5° 60 min 90% 3°,4°,5° 90 min 80% Priority Time Reliability lo 15 min 70% 2 15 min 70% 3°,4°,5° 90 min 70% Exbibit B, Page 3 EXHIBIT C MEMORANDUM OF UNDERSTANDING This Memorandum of Understanding is to confirm the discussion of the tentative agreements reached with respect to some of the issues involved in the conversion of the paramedic service arrangement to a countywide "Enterprise Fund Model." This understanding is based on previous discussions between representatives of Texas Lifeline Corporation (herein "TLC'), Richard Neuhaus, members of the Fort Worth Ambulance Authority, its consultant, Jack Stout, and the November 1987 report to the Fort Worth Ambulance Authority from the Fourth Party, Inc. by Jack Stout entitled "Expanding the MedStar System; Issues, Options, and Recommendations". The parties acknowledge that this Memorandum of Understanding does not constitute a contract but will be attached to and incorporated in the Interlocal Cooperative Agreement and serve as a guide for the new contract to be executed between TLC and the Multi-Jurisdictional Ambulance Authority. These understandings are summarized as follows: 1. Ambulance Authority The Fort Worth Ambulance Authority would be converted to a multi-jurisdictional agency (herein the "Multi-Jurisdictional Ambulance Authority") pursuant to the Interlocal Cooperative Agreement. The Multi-Jurisdictional Ambulance Authority would be a legal entity separate from its city members and would own, control, manage, and administer the accounts receivable and the billing system. Title to infrastructure property and equipment would be transferred to the Multi-Jurisdictional Ambulance Authority by the City of Fort Worth on some basis to be negotiated between the two of thern. The contract between the City of Fort Worth and TLC would be renegotiated and replaced with a new contract between TLC and the Multi-Jurisdictional Ambulance Authority on the basis of terms and conditions set forth in this Memorandum of Understanding and as negotiated to the extent not agreed to herein. The term of the contract would be extended by thirty-nine (39) months with the same provisions for earned renewals as are included in the current contract. 2. Per Capita Management Fee The contract between TLC and the Multi-Jurisdictional Ambulance Authority will provide for compensation to the contractor on the basis of a per capita rate multiplied by the population in the service area under agreement with the Multi-Jurisdictional Ambulance Authority each time a city is added. The per capita fee will be arrived at using the following methodology: 1.) Using Fort Worth historical demand, determine the annual gross volume of infra-jurisdictional transports and multiply times $230.00 per emergency transport and $153.33 per non-emergency transport to arrive at a projected gross revenue figure; 2.) Multiply the projected gross revenue figure by 63% to arrive at a projected net revenue (under the Failsafe Franchise Model) figure; 3.) Subtract the actual cost of billing and collection; 4.) Subtract $3.00 per transport; for payment of the EPAB fee which will no longer be the responsibility of the contractor; 5.) Add the annual amount of first year subsidy from Fort Worth, $875,000.00; 6.) Divide the total amount by the population covered (using COG official figures), to arrive at a per capita figure; 7.) Adjust the per capita figure by the CPI; 8.) Adjust the per capita figure to account for the charges in the definition of the expanded Service Area. Both parties agree that an adjustment needs to be negotiated to reflect the differences in the extended Service Area; and then 9.) Multiply the per capita fee, thus calculated, times the population in the newly contracted Service Area (again using the COG figures), and dividing by 12 to determine a Base Monthly Fee for intra- jurisdictional work (excluding "extra-work" items). In no event will the total monthly payment be reduced (because of a reduction in Service Area size or population) without at least 365 days prior notice unless a member city withdraws for due cause, based on contractor's default as defined in the Interlocal Cooperative Agreement. In addition, the contractor will be paid for "extra work", for long distance transfers, special events coverage, DRG transports, and transports in excess of the current per capita transport rate in the City of Fort Worth. The fees for various categories of "extra work" have not yet been negotiated but would be similar to such terms as they appear in the Pinellas County RFP. The per capita rate would be discounted by two percent (2%) after total population in the service area exceeds 700,000 and by one percent (1%) additional for each incremental population increase of 42,000 up to a maximum discount of fourteen percent (14%). 3. Existing Accounts Receivable The parties have agreed to conduct an independent appraisal of the net value of outstanding accounts receivable based on current collection practices less the reasonable costs of collection and will not be reduced by a present cash value discount. All outstanding accounts receivable would then be assigned by TLC to the new Multi-Jurisdictional Ambulance Authority. The Multi-Jurisdictional Ambulance Authority would give TLC a negotiable promissory note for the agreed upon net value of transferred accounts receivable. The note would bear no interest for the first year, interest at the rate of nine (9%) thereafter or the rate charged by Texas American Bank on the existing operating capital loans, whichever is less, and will be payable in twenty-four(24) equal payments beginning twenty-Four(24) months after the date on which the accounts receivable are transferred. That note and/or the accounts receivable would continue to collateralize the existing operating capital loans from Texas American Bank. TLC would continue to be responsible for interest on the operating capital loan for twelve (12) months after the date the accounts receivable are transferred. This arrangement will be subject to the approval of Texas American Bank. 4. Billinn System Hardware Software and Management Consulting/Maintenance TLC proposes to lease its billing system hardware, software and software support (including upgrades) to the new Multi-Jurisdictional Ambulance Authority for a monthly fee equal to its actual cost, beginning August 1, 1988. In addition, TLC will provide management consulting and system maintenance serv}ces for$2,500 per month. Both arrangements will be for an initial term of six (6) months. Thereafter the Multi-Jurisdictional Ambulance Authority will have the option to continue all or a portion of the arrangement to purchase either the computer hardware (for its fair market value, but for not less than the amount of any unamortized debt on said hardware) or the software package or to terminate the use of the hardware and software without penalty. In the event it is the Multi-Jurisdictional Ambulance Authority's decision to terminate said use, TLC shall cooperate fully in effecting the conversion of the data to the Authority's new system. 5. Three-Way Lease Agreement The existing three-way lease agreement covering ambulances and medical equipment between TLC and the Fort Worth Ambulance Authority would be assigned by the Fort Worth Ambulance Authority to the Multi-Jurisdictional Ambulance Authority. The Fort Worth Ambulance Authority would not be released under the current lease without the prior consent of Texas American Bank, however, under no circumstances would the dollar amount if its liability be increased above the then current level. All new equipment purchased by TLC to be used under the contract would be leased directly to the Multi-Jurisdictional Ambulance Authority and subleased to TLC. The Fort Worth Ambulance Authority would not be involved as a master lessee and there would be no actual or implied guaranty of the lease arrangement by the City of Fort Worth or the Fort Worth Ambulance Authority. All ambulance and medical equipment currently owned by Meissner-Brown which would be used under the contract would be leased by Meissner-Brown to the Multi- Jurisdictional Ambulance Authority which would sublease to TLC. The lease payments to Meissner-Brown will be set at a monthly rate necessary to amortize the current value of the leased equipment over its remaining useful life, but not more than the amount of the sub-lease payments related to the same equipment paid to the Multi- Jurisdictional Ambulance Authority by TLC. 6. Subscription Program TLC will send a letter to all current subscribers soliciting renewals for a sixteen (16) month term beginning April 1, 1988. TLC's direct costs will be reimbursed from the renewal proceeds and the balance shall be divided pro rata as of the conversion date the Multi-Jurisdictional Ambulance Authority assumes control over the system. As consideration for the transfer of the subscription rights, the Multi-Jurisdictional Ambulance Authority will pay $58,500. 7. Meissner-Brown The parties acknowledge that TLC has purchased the assets and goodwill of Meissner-Brown on an installment contract amortized over seven (7) years. The parties further acknowledge that the contemplated system conversion will result in a partial or total merger of the Meissner-Brown operation into the Medstar operation. In the event the TLC contract should be terminated prior to the full amortization of the purchase price for Meissner-Brown, the Multi-Jurisdictional Ambulance Authority will continue to make payments to Meissner-Brown for the amortized cost of the goodwill portion of the Meissner-Brown purchase. In return, TLC and Meissner- Brown will waive any and all claim they may otherwise have to the assets and goodwill value in the Meissner-Brown operations being contributed to the converted ambulance system. 8. Service to Non-Contiguous Urban Areas and Suburban Areas The parties acknowledge that service to rlon-contiguous urban areas and to suburban areas is more expensive for the same level of service because of greater distances and time between revenue producing transports. Additionally, on a per capita contract, the population base is too small to justify the same level of response time commitment. Therefore, it is understood that the contract between TLC and the Multi-Jurisdictional Ambulance Authority will provide for a higher per capita fee in such areas or, in the alternative, a lower level of response time commitment commensurate with the greater expense attributable in those areas; provided, however, that in no event shall the City of Fort Worth receive a lower level of service or a higher price/ subsidy combination than that already established under its current contract with TLC (except for ordinary inflation of the Uniform Schedule of Price/ Subsidy Options as approved by the Multi-Jurisdictional Ambulance Authority). Attached is a proposed table of response time commitments fob- the per capita fee described in paragraph #2 above. 9. Termination of Interim Agreement Although no formal, written interim agreement was executed in the spring of 1987, the major elements of the recommendations included in the Fourth Party's "Twelve Thousand Mile Tune-Up" report have been implemented. It is agreed that the new contract contemplated in this Memorandum of Understanding would supersede and terminate such interim understandings, that the increase in subsidy payments will terminate with the March 10, 1988 payment and that the increased fee for service will remain in effect until the new contract becomes effective August 1, 1988. This letter sets forth all of the issues the resolution of which the parties considered critical to a determination to move forward with the contemplated EMS system conversion and expansion to a multi-jurisdictional service. However, the parties acknowledge that there are many other issues which have been discussed and will be addressed in greater detail during negotiation of the new contract. Those additional issues include but are not necessarily limited to assignment of existing Meissner-Brown contracts to the Multi- Jurisdictional Ambulance Authority, drafting and executing an Interlgcal Cooperative Agreement which includes provisions for first responders and agreement to appoint EPAB as the medical control authority, upgrading and/or relocating the dispatch center, establishing facilities for a training center, refinancing and remodeling the existing building, drafting and adopting a model ordinance including provisions regarding wheelchair service, and financing the acquisition of ETAK. Contiguous Noll-Coll f iguous Priioorit,y Time Reliability Priori Time Reliability 1° 8 min 90% 1° 10 min 80% 2° 10 min 90% 2° 12 ruin 80% 3°,4°,5° 60 min 90% 3°,4°,5° 90 min 80% Pn'odty Time Reli_ ability niority Time Reliability lo 10 min 90% 1° 12 min 80% 20 12 min 90% 2° 14 min 80% 3°,4°,5° 60 min 90% 3°,4°,5° 90 min 80% PHoTjjy Time Reliability lo 15 min 70% �GI 2° 15 min 70% 3°,4°,5° 90 min 70% e•� � N 4 00 � O •rl t-1 � M v U0 rF)- 00 V tv W � O F a v � a u C� O W W •rl N O .�..+ US. •►�+ O LF) CD O O O O O O O O O M N N 6F? 6F). Za E X W ijig a!SV.Iand wnwixeW City of Fort Worth, Texas Mayor and Council Communication DATE REFERENCE SUBJECT: APPROVAL OF EMS INTERLOCAL PAGE 4/12/88 NUMBER 10918 COOPERATION AGREEMENT ADOPTION OF 1 o 3 UNIFORM EMS ORDINANCE Recommendation It is recommended that the City Council : 1) Authorize the City Manager to execute the attached EMS Interlocal Cooperation Agreement; and 2) Adopt the attached Uniform EMS Ordinance; and 3) Appoint William Garrison, Bert Williams, Gary Gilley, and W. M. Lawhon as Fort Worth's Area Metropolitan Ambulance Authority Board Members. Discussion Following the. recommendations approved by the Fort Worth Ambulance Authority and presented to City Council at its December 8, 1987, pre-council meeting, the City' s EMS Consulting firm, The Fourth Party, developed the attached EMS Interlocal Cooperation Agreement and Uniform EMS Ordinance as the legal instruments to effect conversion of the current MedStar system to a multi- jurisdictional ambulance authority. The Agreement and Ordinance were discussed with City Council during the pre-council meeting on April 5, 1988 ( I.R. 7270) . Interlocal Cooperation Agreement Adoption of the Agreement by the City of Fort Worth and at least one other jurisdiction will create the Area Metropolitian Ambulance Authority. The Authority will be responsible for the provision of ambulance services to all member jurisdictions through a contract with a private provider which shall be competitively awarded from time to time; implementation of an ambulance service subscription program which allows member residents to annually purchase and prepay all uninsured portions of medically necessary ambulance service; and assumption of EMS billing and collection functions currently performed by Texas Lifeline Corporation. The Ambulance Authority' s Board of Directors will be composed of nine members, one of which is the Medical Director of the Emergency Physicians Advisory Board. Until such time as the total population of all member jurisdictions exceeds 880,000 persons, the board will be composed of four members appointed by Fort Worth, two members appointed by the City of Arlington, if it chooses to participate, and one member representing each 110,000 persons residing within all other member jurisdictions combined, but no less than one representative. Fort Worth may appoint the current Fort Worth Ambulance Authority members as its board representatives on the new Authority. At such time as the total population of all member jurisdictions exceeds 880,000, Fort Worth and Arlington may each appoint one board member for each 1/8th of the total population represented by each respective city. All other member jurisdictions will appoint one board member for each 1/8th of the then current population of all member jurisdictions. • M y DATE REFERENCE SUBJECT: APPROVAL OF EMS INTERLOCAL PAGE 4/12/88 NUMBER COOPERATION AGREEMENT ADOPTION OF 2 3 C-10918 _UNIFORM EMS ORDINANCE -- Of --- Initial membership in the Authority requires no financial investment on the part of jurisdictions not currently subsidizing ambulance operations. The Agreement specifies that any member jurisdiction which subsidizes ambulance services during fiscal year 1987-88 will agree to subsidize the Authority in an amount not less than 90% of that member's 1987-88 subsidy during the Authority's first year of operation, beginning August 1, 1988. The subsidy can be reduced by no more than 10% of the 1987-88 amount in subsequent years, until the Authority' s net worth reaches $5,000,000 or 50% of its annual operating budget, whichever is greater. At that time, the 10% cap on subsidy reduction will be waived, and member jurisdictions may then accelerate their annual reduction beyond the 10% limit. The first year Fort Worth subsidy to the Authority, beginning August 1, 1988, will be $1 ,188,287, and may be reduced by $132,032 each year thereafter. Volume discounts will be offered member jurisdictions as the system expands. The discounts range from two to fourteen percent, depending upon the collective population of all member jurisdictions. Each jurisdiction will receive its share of discounts based on its pro rata share of the total population served by the Authority, and may use the discounts in any of the following ways: To reduce the price or subsidy level applicable in that jurisdiction; To reduce the cost of subscription membership for residents of that jurisdiction; To recover costs of developing and implementing the MedStar system; or Any combination of the above. As they become available, Fort Worth may use its discounts to recover the costs incurred from July, 1985 to August 1 , 1988, in developing the MedStar system. The current assets and liabilities of Fort Worth, including the medical communications systems, facility, and telephone lines will be transferred to the Authority. The Authority will assume responsibility for payments of these items. Each legal instrument used to effect the transfer will require City Council approval , and will be structured so that the current financial liability of Fort Worth will not be increased, and will decrease over time. Uniform EMS Ordinance Adoption of the ordinance creates the Emergency Physicians Advisory Board (EPAB) in the same manner as the current ordinance. Exemptions from licensing requirements are also similar to the current ordinance, with the addition of a set of exemptions relating to wheelchair transport services. The Fort Worth Ambulance Authority has met with the consultant on a regular basis and in its meeting on March 28, 1998, approved the Interlocal Cooperation Agreement and Uniform EMS Ordinance and recommends approval by the City Council . A DATE REFERENCE SUBJECT: APPROVAL OF EMS INTERLOCAL PACE 4/12/88 NUMBER COOPERATION AGREEMENT ADOPTION OF 3 0+ 3 C-10918 IINTFORM EM ORDINANCE Upon approval of these instruments by City Council , negotiations will begin on conversion of the current Texas Lifeline Corporation contract, transfer of the current MedStar system infrastructure, financing of required infrastructure improvements, conversion of the accounts receivable management responsibility, transfer of the three-way leasing program, conversion of the lock box banking arrangement, transfer of the MedStar trade name and provider license, development of a detailed long range financial plan, and other business transactions. In any event, City Council and Ambulance Authority approval will be required on all of these documents before they are implemented. The schedule projects an August 1, 1988 start-up date for the new system. BT:wg APPROVED BY CITY COUNCIL f w..�..o.,,,�-_..._.�..-._....tee,a....�.. CURMITIfU F(%R T,,[ MANA ,r:' <, Bob Terrell r� s,.� y4 T t , u"r.iNAr:NC , fPARTMENT HEAP B. Terre] l R Ari UITIC NAL INfORMAT��)N ;NTACT Neuhaus 6170 ' " ' -- •'.•"�� %7 ". � K _ _.