title
ADOPT A RESOLUTION TO PARTICIPATE IN THE CENCAL FIRE EMS AUTHORITY, A JOINT POWERS AUTHORITY
recommended action
RECOMMENDATION
It is recommended that the City Council adopt a resolution to:
1. Authorize the City Manager to enter into an agreement with the City of Lodi and the South San Joaquin County Fire Authority to join and participate in The CENCAL Fire EMS Authority (CENCAL), a Joint Powers Authority (JPA); and
2. Authorize Mayor Christina Fugazi to serve as the City of Stockton’s Primary Director on the CENCAL Board of Directors; and
3. Authorize Councilmember Michele Padilla to serve as the City of Stockton’s First Alternate Director on the CENCAL Board of Directors in the absence of the Primary Director; and
4. Authorize Vice Mayor Jason Lee to serve as the City of Stockton’s Second Alternate Director on the CENCAL Board of Directors in the absence of both the Primary Director and the First Alternate Director; and
5. Authorize the creation of a separate restricted fund (CENCAL EMS Fund) to track all revenues and expenditures associated with CENCAL; and
6. Authorize the transfer of $1,515,700 from the General Fund Reserves to the CENCAL Fund; and
7. Authorize the City Manager to transfer or expend $1,515,700 from the CENCAL EMS Fund as needed for startup costs associated with CENCAL; and
8. Authorize the City Manager to take all appropriate actions to carry out the purpose and intent of this resolution.
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Summary
The San Joaquin County Emergency Medical Services Agency (SJCEMSA) oversees emergency medical services (EMS), including managing exclusive operating areas (EOAs) for ambulance providers in San Joaquin County. With an upcoming expiration of the current ambulance transport provider agreement, the Stockton Fire Department (SFD), Lodi Fire Department (LFD), and South San Joaquin County Fire Authority (SSJCFA) aim to partner with a private ambulance provider to submit a joint proposal to provide prehospital emergency medical services in one of more of SJCEMSA’s EOAs. The creation of The CENCAL Fire EMS Authority (CENCAL), a Joint Powers Authority (JPA), is necessary for SFD, LFD, and SSJCFA to jointly oversee the delivery of these services.
DISCUSSION
Background
A Local Emergency Medical Services Agency (LEMSA) is a county-level organization responsible for coordinating and regulating emergency medical services (EMS) within its jurisdiction under the authority granted by California Health and Safety Code Section 1797.200. The San Joaquin County Emergency Medical Services Agency (SJCEMSA) serves as the LEMSA for San Joaquin County, overseeing EMS providers and ensuring quality standards in emergency medical care. According to California Health and Safety Code Section 1797.224, the LEMSA has the legal authority to establish exclusive operating areas (EOAs) for ambulance services. Through EOAs, the LEMSA can designate specific ambulance service providers to operate in defined areas, enhancing efficiency and coordination in the delivery of emergency medical services.
In December 2014, SJCEMSA entered into an agreement with American Medical Response (AMR) to provide emergency and advanced life support ambulance services in Zone X. Zone X is one of four EOAs (Attachment A) in the County that covers the greater Lodi, Stockton, and Tracy areas. The AMR agreement is set to expire in May 2026.
In anticipation of the upcoming SJCEMSA Request for Proposals (RFP) for emergency ambulance services in one or more EOA, SFD, LFD, and SSJCFA collaborated on a comprehensive analysis of SJCEMSA’s ambulance service area. The goal was to explore the feasibility of submitting a joint proposal to SJCEMSA, enabling the three fire agencies, in coordination with a private ambulance provider, to collectively serve one or more EOAs. The analysis concluded that a joint response to the SJCEMSA RFP was advantageous.
To proceed with a joint response to the upcoming SJCEMSA RFP, SFD, LFD, and SSJCFA entered into a Memorandum of Agreement (MOA). This MOA (Attachment B) authorized the issuance of a joint RFP for emergency and non-emergency ambulance services, including but not limited to ground ambulance transportation, 9-1-1 emergency dispatch assistance, interfacility transportation, and critical care transportation. The goal was for these services to be contracted by a JPA, contingent upon receiving one or more satisfactory proposals, with the intention of submitting a unified proposal to the SJCEMSA RFP. On October 29, 2024, SSJCFA issued an RFP on behalf of all three fire agencies in accordance with the MOA. A satisfactory proposal was received from American Medical Response (AMR).
The creation of a JPA is necessary to proceed with a joint submission to the SJCEMSA RFP. A JPA is a legal entity that allows two or more public agencies, such as cities, counties, or special districts, to collaborate on shared goals while retaining their individual powers. The JPA formalizes the partnership between the SFD, LFD, and SSJCFA, providing a unified legal and operational framework to present a cohesive and competitive proposal to SJCEMSA. It demonstrates organizational stability, shared governance, and the capacity to effectively manage the contracted services while enhancing accountability and operational efficiency.
Present Situation
If authorized by Council, SFD will join LFD and SSJCFA to establish The CENCAL Fire EMS Authority (CENCAL), Joint Powers Authority.
Under the JPA structure, CENCAL will be a separate legal entity, with the primary purpose of managing emergency medical transportation in one or more EOA. This includes emergency ground ambulance services, 9-1-1 dispatch assistance, interfacility transport, and critical care transport. CENCAL will have the authority to contract, incur debts, accept contributions, manage property, and dispose of assets as necessary to fulfill its operational goals.
CENCAL will be governed by a three-member Board of Directors, with each participating entity appointing one Director. CENCAL will be structured to protect the interests of each entity with each Director holding one vote. Most decisions will require a simple majority, while financial decisions will require unanimous consent.
CENCAL will share costs and responsibilities among each member entity via a pro-rata share based on population served, with allocations reassessed every five years. Once operational, CENCAL’s funding will come from revenue generated by services provided. In the event of a shortfall in revenue or an inability to meet financial obligations, the member entities will share the deficit proportionally to prevent operational disruptions. However, any debts incurred by the JPA will remain the responsibility of the JPA itself, in accordance with California Government Code Section 6508. Should CENCAL generate excess revenue, those funds will be reinvested into EMS improvements, as determined by the CENCAL Board of Directors.
CENCAL will contract with AMR to establish a regional public-private partnership to enhance emergency ambulance transport services in San Joaquin County. AMR will collaborate with CENCAL to develop and implement an integrated operational framework that aligns with the performance metrics, regulatory standards, and operational goals outlined in the forthcoming SJCEMSA RFP. Together, CENCAL and AMR will create a streamlined and adaptable system to address the evolving demands for ambulance services in the region, focusing on optimizing resource deployment, enhancing response effectiveness, and ensuring compliance with both state and county EMS regulations.
This partnership will create a unified chain of responsibility, ensuring seamless coordination from the moment a 911 call is received to the transfer of patient care at the appropriate destination. By increasing the number of ambulances by an estimated 11%, the JPA will enhance service availability and response times, ensuring a quicker and more effective response to emergency situations. Additionally, the partnership will also offer flexibility during high-demand periods and large-scale incidents, ensuring service continuity in complex situations.
The centralized structure of the JPA will enable consistent data collection and analysis across multiple EMS jurisdictions. This data-driven approach will provide valuable insights into response patterns and performance metrics, facilitating informed decision-making and supporting continuous quality improvement initiatives. Ultimately, these enhancements will not only improve operational efficiency but also increase public safety, ensuring that the community receives the highest level of care during emergencies.
The JPA also offers a significant strategic advantage in cost recovery and revenue generation. As a public entity, the JPA qualifies for a more favorable Medicare reimbursement rate from the federal government, which enhances the financial viability of the transport services. This reimbursement rate is notably more advantageous than the rate AMR, as a private provider, is eligible to receive. By structuring the transport services under the JPA, even if subcontracted to a private provider like AMR, the JPA can access enhanced reimbursement rates, resulting in increased revenues that would otherwise be unavailable to AMR alone.
CENCAL and AMR will submit a joint proposal to the upcoming SJCEMSA RFP for emergency ambulance transport services. This proposal will leverage the strengths of both entities, combining CENCAL’s favorable reimbursement rates with AMR’s operational expertise and resources. Together, CENCAL and AMR will present a comprehensive plan to enhance ambulance services within one or more EOAs, emphasizing improved response times, higher quality of care, and adherence to all state and county regulatory requirements. CENCAL’s agreement with AMR will include a non-compete clause designed to safeguard the interests of all parties as SJCEMSA completes the RFP process.
The continuation of CENCAL is contingent upon the successful award of transport rights under the SJCEMSA RFP. If CENCAL’s proposal is not selected, or if SJCEMSA issues an RFP that significantly deviates from San Joaquin County’s current EMS model, making it no longer feasible for the JPA to submit a proposal, the JPA will be dissolved. In either case, AMR will be released from its non-compete obligation, allowing them to participate independently in the SJCEMSA RFP if they choose.
CENCAL FUND
The City of Stockton (Stockton) will serve as CENCAL’s Treasurer. As Treasurer, Stockton will manage the JPA’s financial health, ensuring compliance with all legal and regulatory requirements. As the custodian of funds, Stockton will oversee all JPA monies while maintaining accurate records in accordance with generally accepted accounting principles. Furthermore, Stockton will be responsible for preparing and monitoring the annual budget, managing cash flow, and ensuring expenditures align with the CENCAL’s policies and applicable law. Stockton will facilitate annual audits, monitor compliance, support strategic financial decision-making, and ensure CENCAL operates with fiscal prudence.
Upon successful award of one or more EOAs to CENCAL by SJCEMSA, the Administrative Services Department will create a restricted fund dedicated to track revenues and expenditures associated with the JPA (“CENCAL EMS Fund”). The establishment of a dedicated CENCAL EMS Fund will enhance transparency, accountability, and fiscal management. This fund will serve as a centralized account to record revenues, expenditures, and other financial activities related to CENCAL, ensuring compliance with financial policies and state regulations. By isolating these transactions, the City can more accurately monitor its financial commitments to the JPA and provide detailed reporting to the member agencies.
FINANCIAL SUMMARY
Staff anticipate a four (4) month interval before CENCAL will receive reimbursements for services rendered. During this period, CENCAL will require $2.3 million to support operations. This includes an estimated $1 million franchise fee to be paid to SJCEMSA for transport rights, $950,000 to fund dispatch services, and $350,000 for general administration and expected fines (SJCEMSA imposes fines for failure to meet response time requirements, which is a standard practice within the emergency medical services industry).
Each JPA member’s pro rata share is estimated as follows:
|
Member |
Percentage |
Amount |
|
Stockton Fire Department |
65.9% |
$1,515,700 |
|
South San Joaquin County Fire Authority |
21.5% |
$494,500 |
|
Lodi Fire Department |
12.6% |
$289,800 |
Upon successful award of one or more EOAs to CENCAL by SJCEMSA, Staff recommends City Council authorize a one-time transfer of $1,515,700 from the General Fund Reserve Balance to the CENCAL Fund to cover the Stockton’s pro rata share of the four month interval period. The one-time transfer amount will be returned to the General Fund Reserve balance by June 30, 2030.
Attachment A - SJCEMSA EOA Map
Attachment B - Memorandum of Agreement