HomeMy WebLinkAboutKWPH Enterprises dba American Ambulance-Emergency Ambulance Services Advanced Life Support Paramedic Ambulance Services_A-25-435 A-17-218-1 A-17-218-2 A-22-374.pdf COtj County of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
601 Board of Supervisors 93721-2198
O� 1$56 0 Telephone: (559)600-3529
FRV,t' Minute Order Toll Free: 1-800-742-1011
www.fresnocountyca.gov
August 19, 2025
Present: 5- Vice Chairman Garry Bredefeld, Supervisor Luis Chavez, Supervisor Nathan Magsig,
Chairman Buddy Mendes, and Supervisor Brian Pacheco
Agenda No. 52. Public Health File ID: 25-0737
Re: Approve and authorize the Chairman to execute Fourth Amendment to Agreement with K.W.P.H.
Enterprises, Inc., d.b.a.American Ambulance to authorize an increase in maximum allowable user fee
rates,with no change to the term of January 1, 2018,through December 31, 2027, or compensation
maximum of$9,035,155
PRIOR TO BOARD DISCUSSION,SUPERVISORS PACHECO, BREDEFELD,AND MAGSIG
RECUSED THEMSELVES UNDER THE LEVINE ACT. DUE TO A LACK OF QUORUM,THE THREE
CONFLICTED SUPERVISORS DREW LOTS,WHICH RESULTED IN VICE CHAIRMAN BREDEFELD
PARTICIPATING PURSUANT TO THE RULE OF NECESSITY.A MOTION WAS MADE BY VICE
CHAIRMAN BREDEFELD,SECONDED BY CHAIRMAN MENDES,THAT THIS MATTER BE
APPROVED AS RECOMMENDED.THE MOTION CARRIED BY THE FOLLOWING VOTE:
Ayes: 3- Bredefeld, Chavez, and Mendes
Recuse: 2- Magsig, and Pacheco
Agreement No. 25-435
County of Fresno Page 53
co
Board Agenda Item 52
O 1856 O
FRE`'�
DATE: August 19, 2025
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Interim Director, Department of Public Health
SUBJECT: Fourth Amendment to the Agreement with K.W.P.H. Enterprises, Inc., d.b.a.
American Ambulance
RECOMMENDED ACTION(S):
Approve and authorize the Chairman to execute Fourth Amendment to Agreement with K.W.P.H.
Enterprises, Inc., d.b.a.American Ambulance to authorize an increase in maximum allowable user
fee rates,with no change to the term of January 1, 2018,through December 31, 2027, or
compensation maximum of$9,035,155.
On June 23, 2025, American Ambulance submitted a written request to the Department of Public Health,
which is the designated local Emergency Medical Services (EMS) agency for Fresno County, requesting
approval to implement an increase to the maximum allowable user fees. This is due to increasing monitoring
fees imposed by the Department of Public Health as a result of increasing Information Technology(IT)
charges for radios and data processing by the County's Information Technology Services Department
(ITSD). The proposed represents an increase of approximately 5.8%. The County's agreement with
American Ambulance requires that the Board of Supervisors approve any user fee adjustments proposed by
American Ambulance. There is no Net County Cost associated with the recommended action. This item is
countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended action, the
Department will be forced to use realignment funds to cover the additional costs since American Ambulance
would not be able to afford the County's increase.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The proposed
Amendment only changes the user fees that American Ambulance is allowed to bill a patient. American
Ambulance does not receive a subsidy from the County for the provision of ambulance services and is only
funded through its user fees. Under the Agreement, the County compensates American Ambulance
approximately$75,000 annually for transport of Fresno County Jail and Fresno County Juvenile Justice
Campus inmates and patients eligible from the County's Medical Indigent Services Program with 1991
Health Realignment funds, which will not be impacted by the user fee adjustment. This proposed increase
will allow the Department to charge American Ambulance a higher monitoring fee, reducing the reliance on
1991 Health Realignment funds to fill in the gaps. Sufficient appropriations and estimated revenues will be
included in the Department's Org 5620 FY 2025-26 Recommended Budget and will be included in
subsequent budget requests for the duration of the contract term.
County of Fresno Page I File Number.25-0737
File Number:25-0737
DISCUSSION:
The Department of Public Health is the designated EMS Agency for Fresno, Kings, Madera, and Tulare
counties, pursuant to Health and Safety Code, section 1797.200, acting as the Central California EMS
Agency.
On May 16, 2017, the County entered into an exclusive operating agreement No. 17-218 with K.W.P.H.
Enterprises, Inc., d.b.a. American Ambulance, for the provision of emergency ambulance services. The
Agreement contains specific performance requirements for ambulance and dispatch services, including
response times, dispatch center operations, and public education and training.
On October 20, 2020, the County executed the first amendment to the EMS Provider Agreement with
American Ambulance for the relocation of the emergency services dispatching and dispatcher training
operations, as well as to make clarifying revisions to the existing EMS Provider Agreement relating to the
integration of the operation of the new EMS Communications Center.
On June 8, 2021, the County executed the second amendment to the EMS Provider Agreement with
American Ambulance to extend the agreement for an additional five-year term from January 1, 2023 through
December 31, 2027, and to allow American Ambulance to implement an Emergency Medical Technician
training program.
On August 23, 2022, the County executed the third amendment to the EMS Provider Agreement with
American Ambulance to increase maximum allowable user fees with the justification of increasing wages for
EMTs, Dispatchers, and paramedics.
On June 23, 2025, American Ambulance submitted a written request to the EMS Agency Director requesting
an increase to maximum allowable user fees due to an increase in monitoring fee requested by the
Department as a result of a sharp increase in IT charges for FY 2025-26 for radio and data processing.
There is a 65% increase in radio charges and 12.5% in data processing charges billed to the Department by
ITSD for the EMS Communications Center from FY 2024-25 to FY 2025-26. The increased monitoring fee is
necessary to provide for long-term budget stability of the Department. These increased costs will also be
negotiated for other users of the EMS Communications Center when new contracts are up starting in FY
2026-27.
While American Ambulance's proposed user fee represents an increase of approximately 5.8%, the result
will affect less than 10% of payors, as more than 90% of patients transported by American Ambulance have
fixed rates under Medi-Cal or Medicare, which will not increase under the recommended action. Patients
with private insurance will be most impacted by the increase.
This is the second user fee increase that American Ambulance has requested since the ambulance
agreement was implemented on January 1, 2018. The ambulance agreement will expire on December 31,
2027.
REFERENCE MATERIAL:
BAI #32, August 23, 2022
BAI #34, June 8, 2021
BAI #34, October 20, 2020
BAI #14, May 16, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk- Fourth Amendment to Agreement with American Ambulance
On file with Clerk- Fee Rate Increase Request
County of Fresno Page 2 File Number.25-0737
File Number:25-0737
CAO ANALYST:
Ronald Alexander
County of Fresno Page 3 File Number:25-0737
Agreement No. 25-435
1 FOURTH AMENDMENT TO AGREEMENT
2 THIS FOURTH AMENDMENT TO AGREEMENT (hereinafter"Amendment") is made and
3 entered into this 191" day of August 2025, by and between COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, Fresno, California (hereinafter"COUNTY"), and K.W.P.H.
5 Enterprises a California Corporation, doing business as AMERICAN AMBULANCE, whose address is
6 2911 E Tulare St. Fresno, CA 93721 (hereinafter"CONTRACTOR").
7 WITNESSETH:
8 WHEREAS, COUNTY and CONTRACTOR entered into Agreement number 17-218, dated May
9 16, 2017 (hereinafter"Agreement"), pursuant to which CONTRACTOR agreed to provide emergency
10 ambulance services to COUNTY; and
11 WHERAS COUNTY's local emergency medical services agency ("EMS Agency") duly
12 established the Fresno County Emergency Medical Services Exclusive Operating Area for the
13 exclusive provision of emergency ambulance services; and
14 WHEREAS, the Agreement was amended for the first time on October 20, 2020, identified as
15 County Agreement 17-218-1; and
16 WHEREAS, the Agreement was amended for the second time on June 08, 2021, identified as
17 County Agreement 17-218-2; and
18 WHEREAS, the Agreement was amended for the third time on August 23, 2022, identified as
19 County Agreement 22-374; and
20 WHEREAS, on June 23 , 2025 CONTRACTOR submitted to the COUNTY's EMS Agency
21 Director a written request to adjust user fee rates primarily due to increased monitoring fees costs
22 imposed by the EMS Agency, as a result of increasing County Information Technology costs.
23 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement in order to
24 raise the user fees charged for emergency ambulance services.
25 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
26 is hereby acknowledged, COUNTY and CONTRACTOR agree as follows:
27 1. That the existing third amendment, County Agreement No. 22-374, Page Two (2),
28 beginning with Paragraph One (1), Line One (1)with the word "The" and ending on Line Fourteen (14)
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1 with the word "minutes", be deleted and the following inserted in its place:
2 "The maximum allowable fees that Contractor may charge patients for
3 services under the Agreement are limited to the following fees.
4 a. BLS Rate .......................................................................... $1,319.70
5 b. BLS Emergency Base Rate ................................................... $2,059.70
6 c. ALS1 Base Rate ................................................................ $1,566.70
7 d. ALS1 Emergency Base Rate ................................................. $2,429.70
8 e. ALS2 Base Rate ............................................................... $2,821.95
9 f. Paramedic Intercept .......................................................... $1,741.25
10 g. Critical Care Transport .................................................... $3,319.45
11 h. Mileage (rate per mile) .................................. $49.00 per loaded mile
12 i. Non-Transport—ALS Treatment Fee ......................................... $500
13 j. Non-Transport—Ambulance Treatment Fee .................................. $200
14 k. Stand-by rate (waiting with patient) ........................... $40.00/15 minutes
15 I. Special Event Stand-by (dedicated unit) ..................... $50.00/15 minutes"
16 2. The parties agree that this Amendment may be executed by electronic signature as
17 provided in this section. An "electronic signature" means any symbol or process intended by an
18 individual signing this Amendment to represent their signature, including but not limited to (1) a digital
19 signature; (2) a faxed version of an original handwritten signature; or (3) an electronically scanned and
20 transmitted (for example by PDF document) of a handwritten signature. Each electronic signature
21 affixed or attached to this Amendment (1) is deemed equivalent to a valid original handwritten
22 signature of the person signing this Amendment for all purposes, including but not limited to
23 evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and effect as
24 the valid original handwritten signature of that person. The provisions of this section satisfy the
25 requirements of Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act
26 (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital
27 signature represents that it has undertaken and satisfied the requirements of Government Code
28 section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely
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1 upon that representation. This Amendment is not conditioned upon the parties conducting the
2 transactions under it by electronic means and either party may sign this Amendment with an original
3 handwritten signature.
4 3. The Parties agree that this Fourth Amendment is sufficient to amend the Agreement, as
5 previously amended, and that upon execution of this Fourth Amendment, the Agreement, First
6 Amendment, Second Amendment, Third Amendment, and this Fourth Amendment together shall be
7 considered the Agreement.
8 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
9 covenants, conditions and promises contained in the Agreement and not amended herein shall remain
10 in full force and effect.
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1 EXECUTED AND EFFECTIVE as of the date first above set forth.
2
3 CONTRACTOR COUNTY OF FRESNO
4 K.W.P.H. Enterprises, dba American
5 Ambulance
6
(Authorized Signature) Ernest Buddy Men es, Chairman of the
9 Board of Supervisors of the County of
Fresno
10 Tnrld Va1arLCE0
11 Print Name&Title
12 ATTEST:
Bernice E. Seidel
13 7 Clerk of the Board of Supervisors
County of Fresno, State of California
14 (Authorized Signature)
15
16 Erik Paterson, Corporate Secretary By:
Print Name&Title Deputy
17 Chief Financial Officer or Corporate Secretary
18
19 Mailing Address
2911 E. Tulare St
20 Fresno, CA 93721
21
22
23
FOR ACCOUNTING USE ONLY:
24
Fund: 0001
25 Subclass: 10000
ORG: 56201695
26 Account: 7295
27
28
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AMERICAN
A M B U L A N C E
June 23, 2025
Mr. Daniel J. Lynch
EMS Director
Fresno County Department of Public Health
1221 Fulton Street
Fresno, CA 93721
Subject: Ambulance User Fee Adjustment Request Due to Increased Monitoring Costs
Dear Mr. Lynch:
Thank you for your letter dated June 13, 2025, regarding the County's increase to EMS
monitoring costs. We value our continued partnership with Fresno County and
appreciate the opportunity to respond to this request.
As noted in your correspondence,the annual contract monitoring cost will increase to
$1,500,000 from $770,403 —an increase of$729,597. While we understand the
operational needs prompting this adjustment, this substantial increase represents a
significant new cost that cannot be absorbed without adversely impacting service
delivery and sustainability.
We respectfully request an ambulance user fee increase of$85.70 to each base rate to
offset the increased cost. Our current user fees have been unchanged since August 2022
and the proposed adjustment would result in the following revised rates:
Service Current Rate Proposed Rate
BLS Scheduled Base Rate $1,234.00 $1,319.70
BLS Emergency Base Rate $1,974.00 $2,059.70
ALS-1 Scheduled Base Rate $1,481.00 $1,566.70
ALS-1 Emergency Base Rate $2,344.00 $2,429.70
ALS-2 Base Rate $2,736.25 $2,821.95
Specialty Care Transport (CCT) $3,233.75 $3,319.45
Mileage (per loaded mile) $49.00 $49.00
Non-transport Assessment $200.00 $200.00
Non-transport ALS Treatment $500.00 $500.00
Standby Rate (per 15 minutes) $40.00 $40.00
ACCREDITED
Since 2000
2911a 93721 • LANCE.
We estimate that only a small portion of patients—approximately 8.8%with private
insurance—will be subject to the increased rates. More than 91%of our patients are
covered by government payers that reimburse at fixed rates, regardless of billed
charges, and therefore would not be affected by this adjustment.
For those with private insurance, California Assembly Bill 716 (effective January 1, 2024)
provides consumer protection by limiting out-of-pocket costs to in-network cost-sharing
amounts. Ambulance providers are required to bill the patient's insurer directly for the
remainder. For uninsured patients, AB 716 limits billed charges to the lower of the
Medicare or Medi-Cal rate. As a result, the proposed fee increase is expected to have
negligible—if any—financial impact on patients.
We believe the requested adjustment is both necessary and reasonable in light of the
County's increased monitoring costs and our limited ability to recover the added
expense. We remain committed to providing high-quality service while upholding
financial accountability and transparency.
Thank you for your continued collaboration. Please feel free to contact me directly if
you have any questions or would like to discuss further.
Sincerel
Todd Valeri
Chief Executive Officer