06-11-19 EMS Work Session Agenda and MaterialsKALISPELL
CITY COUNCIL
EMS SUBCOMMITTEE
AGENDA
June 11, 2019, at 6:00 p.m.
First Floor Conference Room, 201 First Avenue East
A. CALL TO ORDER
B. DISCUSSION ITEMS
1. Emergency Medical Services
Services
C. PUBLIC COMMENT
Persons wishing to address the council are asked to do so at this time. Those addressing
the council are requested to give their name and address for the record. Please limit
comments to three minutes.
D. CITY MANAGER, COUNCIL, AND MAYOR REPORTS
E. ADJOURNMENT
UPCOMING SCHEDULE / FOR YOUR INFORMATION
Next Regular Meeting — June 17, 2019, at 7:00 p.m. — Council Chambers
Next Work Session — June 24, 2019, at 7:00 p.m. — Council Chambers
Reasonable accommodations will be made to enable individuals with disabilities to attend this meeting.
Please notify the City Clerk at 758-7756.
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City of Kalispell
Post Office Box 1997 - Kalispell, Montana 59903-1997
Telephone (406) 758-7700 Fax - (406) 758-7758
MEMORANDUM
To: Honorable Mayor Johnson and City Council
From: Doug Russell, City Manager
Re: EMS delivery options
Meeting Date: June 11, 2019
BACKGROUND: During budget discussions regarding Emergency Medical Services, the City Council
requested reconvening the EMS subcommittee to discuss options related to soliciting requests for
proposals for the provisions of these services.
This follows from previous efforts to address the fiscal challenges in funding this service. Previous
efforts have included a ballot request to the public, revamping the rate schedule, and various activities to
facilitate efficiencies within the operations. The operation continues to require a transfer from the general
fund in order to meet financial requirements of the operations, prompting the discussion during budget
sessions.
Attached to this agenda item is the agreement the City of Great Falls has which outlines respective roles
and responsibilities. At the meeting, we will review respective components of this agreement for
consideration in a solicitation.
RECOMMENDATION: It is anticipated the EMS Subcommittee will discuss the options related to a
solicitation of services.
ATTACHMENTS:
The City of Great Falls agreement for the provision of Emergency Medical Services
AN AGREEMENT WITH GREAT FALLS EMERGENCY SERVICES AND THE CITY OF
GREAT FALLS, MONTANA FOR CITYWIDE 911 EMERGENCY AMBULANCE
SERVICES
TABLE OF CONTENTS
SECTION 1 — ADMINISTRATION OF THE CONTRACT AND TERMS ...................................... 3
1.1
Contract Administration......................................................................................................... 3
1.2
Terms of Contract................................................................................................................. 3
1.3
Conditions for Contract Extension......................................................................................... 3
1.4
Contract Service Area........................................................................................................... 3
1.5
Notices.................................................................................................................................. 3
SECTION 2 — ROLES AND RESPONSIBILITIES....................................................................... 4
2.1 City's Functional Responsibilities.......................................................................................... 4
2.2 Contractor's Functional Responsibilities............................................................................... 4
2.3 Medical Control..................................................................................................................... 5
SECTION 3 — DEPLOYMENT..................................................................................................... 6
3.1 Deployment Plan................................................................................................................... 6
3.2 On -Going Deployment Plan Requirements.................................................. ........ 7
3.3 Annual review of Deployment Plan .................................................. _................................... 7
3.4 Standby................................................................................................................................. 7
SECTION 4 - OPERATIONS ....................................................................................................... 7
4.1 Response Time Standards.................................................................................................... 7
4.2 Dispatch Requirements......................................................................................................... 10
4.3 Equipment and Supplies .......... __ ................................................................. .................... 10
4.4 Disaster Preparedness.......................................................................................................... 12
4.5 System Committee Participation........................................................................................... 12
4.6 First -Responder Program Support ............. ....................... ............ _............................. _...... 13
SECTION 5 - PERSONNEL.........................................................................................................13
5.1 Clinical and Staffing Standards............................................................................................ 13
5.2 Safety and Infection Control................................................................_............. 14
SECTION 6 — QUALITY/PERFORMANCE ................................................................................. 14
6.1 Continuous Quality Improvement Program........................................................................... 14
6.2 Inquiries and Complaints....................................................................................................... 14
SECTION 7 — DATA AND REPORTING..................................................................................... 15
7.1 Data System Hardware and Software.... ............................. ................................................. 15
7.2 Uses and Reporting Responsibilities..............,............................,........................................ 15
7.3 Pre -Hospital Care Reports.................................................................................................... 15
7.4 Inspection of Records and Reports..................................................................................I... 15
7.5 Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 ................ 15
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SECTION S - SUBCONTRACTING........................................................ ...... 16
8.1 General Subcontracting Provisions....................................................................................... 16
8.2 Relationships and Accountability.......................................................................................... 16
8.3 Performance Criteria............................................................................................................. 17
SECTION 9 -ADMINISTRATIVE REQUIREMENTS.................................................................. 17
9.1 Performance Security............................................................................................................ 17
9.2 Insurance............................................................................................................................. 18
9.3 Indemnification.....................................................................................................
SECTION 10 -- FISCAL REQUIREMENTS................................................................................. 19
10.1 Annual Subsidy. .................................................................................................................. 19
10.2 General Provisions.............................................................................................................. 19
10.3 Billing and Collections......................................................................................................... 19
10.4 Reporting Responsibilities................................................................................................... 20
10.5 Damages.............................................................................................................................20
10.6 Compensation to City.......................................................................................................... 20
SECTION 11 - GENERAL CONTRACT REQUIREMENTS........................................................ 21
11.1
Contract Termination...........................................................................................................
21
11.2
Declaration of Major Breach and Takeover/Replacement Service ......................................
23
11.3
Dispute After Takeover/Replacement ..... .......... ..................................................................
23
11.4
Breach Not Dangerous to Public Health and Safety...........................................................
24
11.5
Liquidated Damages...........................................................................................................
24
11.6
City Responsibilities..,........................................,................................................................
24
11.7
"Lame
Duck" Provisions..............................................,.......................................................
24
11.8
Equal Employment Opportunity ... ................................................ .......................................
25
11.9
Independent Contractor Status...........................................................................................
25
11.10
Non -Assignment and Non-Delegation...............................................................................
25
11.11
Conformance to Regulations.............................................................................................
25
11.12
Conformance to Law.........................................................................................................
25
11.13
Reports.............................................................................................................................
26
11.14
Changes.......,..................................................................................................................26
11.15
Retention of Records and Record Keeping, Accounting Practices ..................................
26
11.16
Force Majeure...................................................................................................................
26
11.17
Severability............................................................ ......26
SECTION 12 - EXHIBITS.............................................................................. .................
29
12.1
Exhibit A:
Reporting Requirements....................................................................................
30
12.2
Exhibit B:
Damages............................................................................................................
33
12.3
Exhibit C:
Quarterly Payment Schedule...................,.........................................................
35
12.4
Exhibit D:
Ambulance Rates..............................................................................
36
12.5
Exhibit E:
Response Zone Map..........................................................................................
37
12.6
Exhibit F:
Non -Emergent Response Damages..................................................................
38
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SECTION 1 —ADMINISTRATION OF THE CONTRACT AND TERMS
1.1 Contract Administration
The City of Great Falls EMS System Administrator will act as the Contract Administrator, and shall
represent the City in all matters pertaining to this Agreement and shall administer this Agreement on
behalf of the City. The Contract Administrator or her/his designee may:
A. Monitor the Contractor's and Subcontractor's EMS service delivery for compliance with
standard of care as defined through law, medical protocols, and policies; and
B. Provide technical guidance, as the Contract Administrator deems appropriate.
1.2 Term of Agreement
The term of this Agreement shall commence at 00:01 hours on May 21, 2014, and shall terminate at
midnight on May 20, 2019, unless terminated earlier or extended pursuant to the terms and conditions
of this Agreement.
1.3 _Agreement Extension
This Agreement is automatically extended for one subsequent five-year term unless either party
provides a written notice at least one year prior to the expiration of the previous five-year term of that
party's intention to terminate the Agreement.
1.4 Contract Service Area
All requirements described in this Agreement apply to the geographical area of the City of Great Falls
and the Fire Districts served by Great Falls Fire Rescue.
1.5 Notices
All notices, demands, requests, consents, approvals, waivers, or communications ("notices") that
either party desires or is required to give to the other party shall be in writing and either personally
delivered or sent by prepaid postage, first class mail, or sent by facsimile (with confirmation receipt).
Notices shall be addressed as appears below for each party, provided that if either party gives notice
of a change of name or address, notices to the giver of that notice shall thereafter be given as
demanded in that notice.
Contractor: Great Falls Emergency Services -Manager
514 9th Avenue South
Great Falls, Montana 59405
Contractor: Great Falls Emergency Services- President
2880 North 55 West
Page 3
Idaho Falls, Idaho 83402
City: EMS System Administrator
City of Great Falls City Manager's Office
P.O. Box 5021
Great Falls, Montana 59403
SECTION 2 — ROLES AND RESPONSIBILITIES
2.1 City's Functional Responsibilities
The City seeks to ensure that reliable, high quality pre -hospital emergency medical care and transport
services are provided on an uninterrupted basis. To accomplish this purpose, the City shall:
A. Oversee and enforce the Contractor's rights as an emergency 911 ambulance service provider
within the City of Great Falls;
B. Oversee, monitor and evaluate contract performance and compliance; and
C. Provide medical direction and control of the City EMS system.
2.2 Contractor's Functional Responsibilities
During the term of this Agreement, the Contractor shall:
A. Provide pre -hospital emergency medical care and transport services at the advanced life
support (ALS level in response to emergency medical calls within the City twenty-four (24)
hours each day, seven (7) days a week, without regard to the patient's financial status;
B. Develop system status management and deployment plans specific to meeting the performance
requirements of the City of Great Falls, continuously monitor the implementation of these plans
and make necessary changes to the plans to meet system requirements;
C. Provide ambulances, as well as other vehicles, equipment, facilities, medical and other supplies
(including fuel, lubricants, maintenance, insurance, appropriate vehicle permits, and
repairs/replacements) that are used by Contractor as necessary for the provision of services
required as part of this Agreement;
D. Furnish supplies and replacements for those used by the Contractor's personnel and provide
replacement supplies used by Great Falls Fire Rescue when providing patient care and
treatment;
E. Establish a recruitment, hiring and retention system consistent with ensuring a quality workforce
of clinically competent employees that are currently certified, licensed and/or accredited;
F. Comply with all training requirements established by the State of Montana, and all applicable
policies and provisions established by the Great Falls EMS Advisory Board, EMS System
Medical Director, and EMS System Administrator;
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G. Maintain neat, clean, and professional appearance of all personnel, facilities, and equipment;
H. Maintain a good reputation through ensuring courteous and professional conduct of office and
field personnel;
I. Maintain good working relationship with law enforcement agencies, first -responder agencies,
hospitals, healthcare providers and other system participants. This shall include working under
the Incident Command System (ICS) and using the National Incident Management System
(NIMS) during all emergency incidents;
J. Establish and maintain a soft supplies exchange program with first -responder agencies,
including Great Falls Fire Rescue. The Contractor will re -supply portable Oxygen to Great Falls
Fire Rescue that was used during EMS incidents.
K. Respond to and comply with ongoing reporting requirements in Exhibit A of this Agreement;
L. Submit, in a timely manner, operational reports, with necessary documentation to support and
verify data provided;
M, Once contractor management becomes aware of incidents in which the Contractor's or
Subcontractor's personnel fail to comply with contractual requirements, Contactor will notify the
City, within two (2) business days.
N. Ensure under this agreement, that all Subcontractors meet all performance and contractual
requirements.
2.3 Medical Control
A. Medical Control — The Great Falls EMS 911 System Medical ❑irector has the exclusive
authority to develop overall medical plans, policies and medical standards to assure that an
effective level of emergency medical care is maintained within the City pre -hospital care 911
system and shall provide ultimate medical control over the entire EMS system to include the
Contractor and Subcontractor's EMS personnel while operating within the EMS 911 system
pursuant to their licensures or certifications. On all matters affecting the quality of patient care,
the EMS 911 System Medical Director directs policy and procedure. The EMS 911 System
Medical Director has system -wide scope of authority, which covers all organizations and
personnel that have a role in the City's 911 EMS system.
B. Functions of EMS 911 S stem Medical Director T- include, but are not limited to:
1. The determination of medical policies;
2. Monitoring of medical aspects of the Contractor's/Subcontractor's emergency 911
performance and formulation of recommendations for improving that performance;
3. The development and enforcement of standard of care protocols or standards required
by the Agreement or by applicable regulations;
4. Serving as the Vice -Chair of the City's EMS Advisory Board;
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5. Serving as the Chair of the EMS system's quality improvement committee; and
6. Conducting periodic quality improvement reviews of the EMS 911 system.
C. Matters included within the a uthodty of EMS 911 System Medical ❑irector — include, but not
limited to;
1. Review and approval of all EMS training programs that are necessary for operation of the
EMS 911 response system;
2. Development and implementation of medical protocols for all EMS 911 system
personnel;
3. Protocols governing the use of helicopters for scene response;
4. Patient destination policies;
5. Equipment, medication and supply inventories;
6. Monitoring compliance and enforcement of the standards of care; and
7. Advising on other medical issues.
D. The cost for the EMS 911 System Medical Director will be shared by the City and the
Contractor. The City will administer the contract far the EMS 911 System Medical Director.
E. The contractor is authorized to contract with an Agency Medical Director of their choice. The
contractor's Agency Medical Director will be advisory on all issues related to plans, policies, and
medical standards related to the city's 911 emergency care system. The contractor is solely
responsible for all cost and actions associated with their Agency Medical Director.
SECTION 3 — DEPLOYMENT
3.1 Deployment Plan
All Contractor emergency 911 ambulance responses under the terms of its Agreement within the City's
jurisdiction shall be dispatched as directed by the Cascade County Consolidated Dispatch Center
(CCCDC) or in compliance with policies and protocols established by the City. Deployment Plans
shall: Specify proposed locations of ambulances and numbers of vehicles to be deployed during each
hour of the day and day of the week;
A. Describe 24 hour and system status management strategies;
B. Describe mechanisms to meet the demand for emergency ambulance response during peak
periods of unusually high call volume;
C. Include a map identifying proposed ambulance stations or post locations;
D. Describe the full-time and part-time work force necessary to fully staff ambulances identified in
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the deployment plans;
E. Describe any planned use of on -call crews;
F. Describe any mandatory (force hire) overtime requirements;
G. Describe how workload shall be monitored for personnel assigned to 24-hour units;
H. Describe record keeping and statistical analyses to be used to identify and correct response
time performance problems;
I. Describe any other strategies to enhance system performance and/or efficiency through
improved deployment/redeployment practices; and
J. Describe the process to keep CCCDC and Great Falls Fire Rescue informed when ambulance
resources are unavailable or not immediately ready to respond to emergencies in the City.
3.2 On-ooina Deplovment Plan Reauirements
An initial deployment plan shall be filed with the City within thirty (30) days from accepting this contract
as part of the Reporting Requirements shown in Exhibit A. A current deployment plan shall be kept
on file with the City. The Contractor shall redeploy ambulances or add additional ambulance hours if
the response time performance standard is not met. The Contractor shall submit proposed changes in
the deployment plan in writing to the Contract Administrator thirty (30) days in advance. The 30-day
prior written notice shall be waived if Contractor is adding resources to its deployment plan or if an
emergency adjustment to the plan is needed to correct an acute performance problem.
3.3 Annual Review of Deployment Plan
The Contractor will provide the City with updated deployment maps on an annual basis.
3.4 Standby: When requested by the City, contractor agrees to provide an ALS ambulance
standby unit for emergent or 911 calls to crime scenes, hazardous materials scenes, fire scenes or
other situations/activities. Payment for such standby will be calculated according to Exhibit D. Once
assigned to the emergency the ambulance assigned must be released by the incident commander.
SECTION 4 — OPERATIONS
4.1 Response Time Standards
A. Response Time Performance — System response times are a key measurement of
performance. This measurement is the determining factor, which drives the placement and
redeployment of the systems resources throughout the entire system.
1. Response time performance is measured by the factors set forth in subsections 4.1 B.
through F. and violations may be imposed damages as in subsections 4.1 G through 1.
For the purpose of the response performance standard, each incident will be counted as
a single response regardless of the number of units that respond, and if the first
response to an incident meets response time requirements, all subsequent responses to
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that incident will be deemed timely. If the first response time is untimely, then damages
will be assessed only as to the first response time
2_ The Contractor shall use its best efforts to minimize variations or fluctuations in response
time performance.
3. For purposes of tracking Contractor response times and reporting, the City boundaries
will encompass the entire ambulance response zone.
4. The Contractor's personnel shall not exceed the posted speed limit by more than 10
miles per hour when responding to code III (emergency lights and siren) calls. Failure to
comply with this requirement may result in damages being assessed as specified in
Exhibit B. All posted speed limits and traffic regulations shall be observed during non -
code III responses.
B. Response Time Standards — An ALS ambulance shall respond to 90% of all emergency calls
each month in the following response zones:
1. Urban Response Zone — 9:00 minutes or less encompassing all responses within the
City limits;
2. Rural Response Zone —12:00 minutes or less encompassing all responses to the City's
Fire Districts; and
3. Super -Rural Response Zone — 20:00 minutes or less encompassing all responses to
properties that may reside outside of the areas above that GFFR may provide EMS
response.
These response zone boundaries are delineated on the map included in Exhibit E.
C. Response Time Exemptions — In some cases, late responses will be excused from financial
damages and from response time compliance reports. Approved response time exemptions
include:
1. Failure by CCCDC dispatcher to give accurate location information (including address or
cross street) to responding units;
2. Weather conditions which impair visibility or create unsafe driving conditions;
3. Call in which the response code is reduced from code III by CCCDC or first responder
during the time the ambulance unit is en route to the dispatched location;
a. If the first responders or CCCDC orders the response slowed to Code I (no
lights and sirens then a 50% increase in response times are allowed.
b. The same damages apply if Code I response times are not met.
c. Non -emergent responses less than 18:00 minutes will not result in damages.
All other non -emergent calls above 18:00 will be assessed damages pursuant
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to Exhibit F, Non -Emergent Response Damages.
4. Wrong address provided by the requesting party;
5. Unavoidable delay caused by unreported road construction;
6. Material change in dispatch location after the initial dispatch is recorded as dispatched.
7. No time recorded by dispatch.
S. When three (3) calls have already been dispatched within the city jurisdiction in any
given rolling 20 minute interval, then subsequent calls are exempt.
Exceptions shall be for good cause only, as determined by the City. The burden of proof that there is
good cause for an exemption shall rest with the Contractor, and the Contractor must have acted in
good faith. The alleged good cause must have been a substantial factor in producing the excessive
response time. Exemptions shall be considered on a case -by -case basis.
Contractor shall file a request for each response time exception on a monthly basis with the City by the
2d'h of each month after receiving the City's Response Time Performance Report for the previous
month. Such request shall list the date, the time, and the specific circumstances causing the delayed
response.
D. Response Time Calculations — Response times shall be calculated from the hour, minute and
second the call is received at the Contractors dispatch center or radio dispatched by CCCDC to
an ambulance, to the hour, minute and second the Contractor arrives on scene with a fully
equipped and staffed AL5 ambulance.
A call is considered "received" by the ambulance when crewmembers have received sufficient
information from the reporting party to initiate the response (i.e. call back number, address, and patient
chief complaint).
E. Applicable. Calls — Response time standards shall apply to all 911 ambulance dispatches.
Each incident shall be counted as a single response regardless of the number of first -
responders or ambulances actually utilized and only the first arriving ambulance's time shall be
applicable. If a response is cancelled, or downgraded to a lower priority, financial damages
may be assessed if the response time standard was exceeded at the time of cancellation or
downgrade.
F. Response Time Performance Report — On the Lath day of each month, the City will provide the
Contractor with a Response Time Performance Report for the previous month identifying each
emergency call:
1. That did not meet response time standard;
2. That an ambulance was requested and was not able to respond; and
3. Where failure to properly report times necessary to determine response time, on -scene
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time, and transport time.
The Contractor shall identify causes of performance failures and document efforts to eliminate these
problems by the 20rn day of each month to the City.
G. Damages for Failure to Provide Data to Determine Compliance — When on -scene time cannot
be provided for a particular emergency call, response time for that call shall be deemed to have
exceeded the required response time for purposes of determining response time compliance.
In order to rectify the failure to report an on -scene time and to avoid the damages, Contractor
may demonstrate to the satisfaction of the City an accurate on -scene time, however, the
response would then be subject to response time damage calculations if response times
exceed response time standards.
H. Infractions — Any infractions of the response time criteria will be submitted by Contractor on the
City's response time form.
I. Response Time Damages Structure — If Contractor and/or Subcontractor fail to meet response
time standards or performance standards in the delivery of service, except as otherwise
exempted, the Contractor shall pay damages in the amounts listed in Exhibit B.
4.2 Dispatch Requirements
A. Dispatch -w The Contractor shall utilize Cascade County Consolidated Dispatch Center
(CCCDC) for emergency 911 ambulance dispatch services.
B. Payment for Dispatch Services — Payments for dispatch services will be made quarterly
according to the schedule outlined in Exhibit C.
C. Communications Equipment -- Contractor shall provide and maintain communications
equipment in good operating condition. Such communications equipment shall be compatible
with existing CCCDC equipment and remain so during the period of this Agreement. Changes
will be coordinated with the contractor. The City agrees to reasonably cooperate with contractor
in its attempts to fund communication equipment.
4.3 Equipment and Supplies
A. Ambulances — All ambulances used under this Agreement shall be type 1, II, or lil, shall be in
good condition, and shall meet or exceed the Federal KKK-A-182FF or then current
standards at the time of the vehicle's original manufacture, except where such standards
conflict with State of Montana standards, in which case the State standards shall prevail. All
such ambulances shall also meet or exceed the equipment standards of the State of
Montana. The Contractor shall assume all costs of and be responsible for all ambulance
and equipment maintenance.
Contractor shall maintain, and provide to the Contract Administrator, a complete listing of all
ambulances (including reserve ambulances) to be used in the performance of this
Agreement, including their license and vehicle identification numbers, and the name and
address of the lien holder, if any. Changes in the lien holder, as well as the transfer of
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ownership, purchase, or sale of ambulances used under this agreement shall be reported to
the Contract Administrator.
B. Ambulance Equipment and Supplies -- Each ambulance shall, at all times maintain an
equipment and supply inventory sufficient to meet Federal and State requirements for ALS
level ambulances, including the requirements of the City. At its cost, Contractor shall be
responsible for stocking all expendable supplies including medications.
All medical equipment shall be in good repair and in working and safe order at all times.
Contractor shall have sufficient medical equipment and expendable supplies so that there is
a sufficient backup to accommodate replacement during repair and for times of excessive
demand in the system.
The Contractor shall furnish, operate, maintain, and replace, as necessary, any and all items
of equipment, apparatus and supplies, whether real, personal, or otherwise, necessary to
fulfill its obligations under the Agreement. The Contractor shall furnish and maintain a
detailed inventory of medical equipment and supplies on board its ALS ambulances.
C. Radio Communications — Contractor shall ensure that each ambulance is equipped with
appropriate emergency communication and alerting devices. Every ambulance shall include
the ability to communicate with CCCDC, Benefis Hospital, GFFR, and other public safety
agencies. Contractor shall ensure that each ambulance utilized in the performance of this
Agreement is equipped with emergency devices capable of being used to notify ambulance
personnel of response needs; and radio communications equipment compatible with
CCCDC communications equipment sufficient to meet or exceed the requirements of City or
CCCDC policies and procedures. Contractor shall have access to an internal radio
communications system including a portable communications link between Contractor's
ambulance crews and its dispatch center.
❑_ Controlled Substances — The Contractor shall have controlled substance policies and
procedures, consistent with Drug Enforcement Administration (DEA) and State of Montana
requirements, to govern the storage, inventory, accountability, restocking, and procurement
of controlled drugs and substances permitted to be carried and utilized in the provisions of
ALS by paramedics.
1. The EMS System Medical Director shall approve all controlled substance policies and
procedures.
E. Safety Equipment — Contractor will follow State and Federal OSHA requirements and shall
provide personnel with equipment necessary to ensure protection from illness or injury when
responding to an emergency medical request.
F. Vehicle Maintenance Program — Contractor's vehicle maintenance program shall be
designed and conducted so as to achieve the highest standards of reliability appropriate to a
modern emergency ambulance service. The Contractor will maintain ambulances and
equipment to the manufacturer's service maintenance schedule.
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1. At its cost, Contractor shall maintain all ambulances. Vehicles shall be kept in excellent
working condition at all times. Any ambulance with any deficiency that compromises, or
may compromise, its performance, shall be immediately removed from service.
4.4 Disaster Preparedness
A. Disaster Plan — Contractor shall have a plan for the immediate recall of personnel to staff units
during multi -casualty situations, or declared disaster situations. This plan shall include the
ability of the Contractor to page and alert off -duty personnel. The Contractor shall participate in
training programs and exercises designed to upgrade, evaluate, and maintain readiness of the
system's disaster and multi -casualty response system.
B. Disaster Planning — Contractor shall actively participate with the City in disaster planning.
Contractor shall designate a representative who shall regularly attend meetings and shall be the
liaison for disaster activities with the City and with other agencies. The Contractor shall provide
field personnel and transport resources for participation in any City disaster drill in which the
City disaster plan or multi -casualty incident plan is tested.
C. Disaster Response — If a disaster declaration is made, the City may suspend normal operations
and the Contractor shall respond in accordance with the disaster plan. The following provisions
may apply, as determined by the Contract Administrator, during and after a disaster:
During such periods, the Contractor may be released, at the discretion of the Contract
Administrator, from response time performance requirements for all responses, including
response time damages. At the scene of such disasters, Contractor's personnel shall
perform in accordance with the City disaster plan.
2. When disaster response has been terminated, the Contractor shall resume normal
operations as rapidly as is practical considering exhaustion of personnel, need for
restocking, and other relevant considerations and shall keep the Contract Administrator
informed of factors that limit Contractor's ability to resume normal operations.
3. During the course of a disaster, the Contractor shall use its best efforts to maintain
emergency service throughout the City, and shall suspend or ration non -emergency
transport work as necessary.
4. The City shall assist the Contractor in seeking reimbursement for its costs for any
disaster relief monies. Such assistance shall be limited to processing claims for
reimbursement equal to 100% of the direct cost of the services, or the allowable standby
charge provided for herein, whichever is greater. The City shall have no financial
responsibility for these costs or charges other than to provide assistance in processing
the claim(s) for payment.
D. At the scene of a mass -casualty incident (MCI), the Contractor's personnel shall perform as part
of the Incident Command System (ICS) structure.
4.5 __ System Committee Participation
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Contractor shall designate personnel to participate in committees that have a direct impact on
emergency medical services for the City, to include, but not be limited to, Great Falls EMS Advisory
Board, EMS Advisory Board subcommittees, including the quality improvement committee. Personnel
participants may include, but not be limited to, president, management, agency medical director,
and staff.
4.6 First -Responder Program Support
A. Contractor agrees to have an effective EMS system that the ALS ambulance and the ALS first -
responders must work as a team to deliver the highest -level and most cost-effective service.
The EMS delivery system must be integrated rather than segregated.
B. Disposable items used by GFFR first -responders in providing patient care and treatment shall
be replaced by Contractor's personnel at the incident scene. If it is not in the best interest of
patient to complete the replacement of disposable items at the incident, GFFR will furnish the
Contractor's personnel with a list of items to be replaced accompanied by the name, if known,
and incident number of the patient for whom the item was used. The Contractor shall, within 48
hours of receipt of the list of items, re -supply GFFR with all items on such list to be delivered to
Fire Station 1, 105 9t' Street South, Great Falls, MT.
C. Within 24 hours, the Contractor shall retrieve and return to GFFR all durable equipment
supplied by GFFR in providing EMS and any other GFFR equipment which has come into the
Contractor's possession.
SECTION 5 — PERSONNEL
5.1 Clinical and Staffing Standards
City expects that the provision of emergency ambulance services shall conform to the highest
professional standards and shall comply with all applicable State laws and regulations, and City EMS
policies, procedures, and field treatment guidelines. All persons employed by the Contractor in the
performance of work under this Agreement shall be competent and shall hold appropriate and
currently valid certificates, licenses or accreditations in their respective trade or profession. The
Contractor shall be held accountable for its employees' licensure, performance and actions. Changes
resulting in a negative fiscal impact to the contractor will be analyzed before implementation.
A. Ambulance Staffing —Contractor shall, at all times, staff each ambulance with at least one
person who is certified and licensed in the State of Montana as a Paramedic and one person
who is certified and licensed in the State of Montana as an Emergency Medical technician
(EMT). Staffing exceptions will be allowed only during times of disaster declaration.
B. Management and Supervision -- Contractor shall provide the management personnel necessary
to administer and oversee all aspects of emergency ambulance service. At least one field
supervisor with emergency medical experience shall be on -duty or on -call at all times to
oversee and provide support to field personnel. The Contractor shall provide to the City a
hierarchal table of organization identifying the management positions and their roles and
responsibilities.
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C. Reauired Certifications — The Contractor shall follow the State of Montana Department of Public
Health and Human Services and the Board of Medical Examiners rules and regulations
regarding the licensure and certification requirements of its employees who work in the City.
D. In -Service Training, Continuing Education and Driver Training — Contractor shall have a
program for ensuring personnel are prepared to respond to emergency requests through in-
service training and continuing education.
1. Contractor shall implement a program, to train EMT personnel to assist Paramedics in
the provision of advanced life support patient care.
2. Contractor shall maintain an on -going driver training program for ambulance personnel.
3. Contractor shall provide in-service training programs related to the EMS Advisory
Board's quality improvement activities and outcomes.
4. Contractor shall allow GFFR personnel to attend in-service training and GFFR will allow
Contractor's employees to attend their in-service training programs.
5. All field level staff shall be trained at the ICS-100 and NIMS 700 level and all field
supervisors shall be trained at the ICS-300 (based on availability) and NIMS 800 level
within 60 days of employment or promotion to supervisor level.
6. Contractor shall provide the City with an annual training compliance letter that
documents that the Contractor's employees are properly trained.
5.2 Safety and Infection Control
The Contractor shall comply with all State and Federal safety requirements, including all applicable
articles in Title 29 of the Code of Federal Regulations.
SECTION 6 — QUALITYIPERFORMANCE
6.1 Continuous Quality Improvement Program
A. Contractor shall participate in the EMS system continuous quality improvement (CQI) program
which interfaces with the local EMS Advisory Board's evolving CQI Program, including
participation in system related CQI activities. The EMS system CQI program shall be an
organized, coordinated, multi -disciplinary approach to the assessment of pre -hospital
emergency medical response and patient care for the purpose of improving patient care service
and outcome. The CQI program should not be limited to clinical functions alone. The program
should include methods to measure performance, identify areas for improvement, and how such
improvements can be implemented and then evaluated, The program shall describe customer
services practices, including how customer satisfaction is determined and how customer
inquiries/complaints are handled.
B. Contractor shall submit an update to the City to show compliance with CQI areas for
improvement.
— ---------- ---- _ _ — Page 14 ..
6.2 Inquiries and Complaints
Contractor shall provide prompt response and follow-up to written inquiries and complaints by the City.
Such responses shall be subject to the limitations imposed by patient confidentiality restrictions.
SECTION 7 — DATA AND REPORTING
7.1 Data Svstem Hardware and Software
Contractor shall utilize a patient care reporting form or system as approved by the State of Montana.
7.2 Uses and Reportina Resoonsibilities
The EMS data system shall be used for documentation of patient medical records, continuous quality
improvement, and reporting aggregate data as specified by Administrative Rules of Montana and the
City. The database system shall contain all EMS responses and patient records. These patient
records shall contain a unique identifier for the patient (e.g., automated dispatch system incident
number), automated dispatch system information for the response, pre -hospital personnel for the
response, patient information (e.g., name, address, insurance), patient history, physical findings, and
treatment rendered. Contractor shall comply with the requirements for the patient care report as
identified in State and local EMS policies.
7.3 Pre -Hospital Care Reports
Contractor shall complete appropriate documentation and pre -hospital care reports according to State
and local EMS policies.
7.4 Inspection of Records and Reports
A. Contractor shall retain and make available for inspection by the City during the term of the
Agreement and for at least a three-year period from expiration of the Agreement all documents
and records required and described herein.
B. At any time during normal business hours, and as often as may reasonably be deemed
necessary, the Contract Administrator, or her/his designee, and the EMS 911 System Medical
Director, may observe the contractor's operations.
C. City representatives may, at any time, and without notification, directly observe and inspect the
Contractor's operation, ride as "third person" on any of the Contractor's ambulance units,
provided however, that in exercising this right to inspection and observation, such
representatives shall conduct themselves in a professional and courteous manner, shall not
interfere in any way with the Contractor's employees in the performance of their duties, and
shall, at all times, be respectful of the Contractor's employer/employee relationship.
D. The City's right to observe and inspect the Contractor's business office operations or records as
defined in this agreement shall be restricted to normal hours, except as provided above.
7.5 _ Health Insurance_ Portability and Accountability Act of 1996, Public Law 104-191
Page 15
A. During the term of this Agreement, each party may receive from the other party, or may receive
or create on behalf of the other party, certain confidential health or medical information
(Protected Health Information "PHI", as further defined below). This PHI is subject to protection
under state and/or federal law, including the Health Insurance Portability and Accountability Act
of 1996, Public Law 194-191 (HIPAA) and regulations promulgated there under by the U.S.
Department of Health and Human Services (HIPAA Regulations). Each party represents that it
has in place policies and procedures that will adequately safeguard any PHI it receives or
creates, and each party specifically agrees to safeguard and protect the confidentiality of
Protected Health Information consistent with applicable law. Without limiting the generality of
the foregoing, each party agrees that it shall have in place all policies and procedures required
to comply with HIPAA and the HIPAA Regulations prior to the date on which such compliance is
required. Contractor shall require subcontractors to abide by the requirements of this section.
B. For purposes of this section, Protected Health Information means any information, whether oral
or recorded in any form or medium: (a) that relates to the past, present or future physical or
mental health or condition of an individual; the provision of health care to any individual; or the
past, present or future payment for the provision of health care to an individual, and (b) that
identifies the individual or with respect to which there is a reasonable basis to believe the
information can be used to identify the individual. This section shall be interpreted in a manner
consistent with HIPAA, the HIPAA Regulations and other state or federal laws applicable to
PHI.
SECTION 8 —SUBCONTRACTING
8.1 General Subcontracting Provisions
All subcontracts of Contractor for provision of services under this Agreement shall be notified of
Contractor's relationship to City.
A. Contractor has legal responsibility for performance of all contract terms including those
subcontracted.
B. Nothing in this Agreement, or in any subcontract, shall preclude the City from monitoring the
EMS activity of any subcontractor.
C. There shall be a section in each subcontract requiring prior approval from the City before any
subcontract may be modified.
D. The Contractor shall assure that the subcontractors cooperate fully with the City.
E. In the event discrepancies or disputes arise between this Agreement and the subcontracts, the
terms of this Agreement shall prevail in all cases.
8.2 Relationships and Accountability
Should the Contractor utilize one or more subcontractors to provide any of the Contractor's primary
responsibilities, the Contractor shall seek and obtain approval of the subcontract(s) from the City, and
provide assurance to the City that each of the subcontractor(s) is professionally prepared for and
Page 16
understands its role within the system.
A. The Contractor shall provide clear evidence that the scope of service designed for the
subcontractor(s) will enhance system performance capability and provide a cost savings for the
EMS System.
B. If the subcontract(s) and associated scope of work is approved, the Contractor shall be
accountable for the performance of the subcontractor(s).
C. The inability or failure of any subcontractor to perform any duty or deliver contracted
performance will not excuse the primary Contractor from any responsibility under this
Agreement.
D. The Contractor shall designate a management liaison to work with the City in monitoring
compliance of subcontractors with contractual and system standards.
8.3 Performance Criteria
All non- Great Falls Fire Rescue subcontractors will be held to the same performance criteria as the
primary Contractor, with respect to quality improvement activities, medical control, continuing
education, and damages for non-compliance. The Contractor shall pay damages for late response
times according to the terms of this Agreement as described in Exhibit B.
SECTION 9 — ADMINISTRATIVE REQUIREMENTS
9.1 Performance Security
Prior to the commencement of operations under the terms and conditions of this Agreement,
Contractor shall obtain and maintain throughout the term of the contract a "contract performance
security" in the amount of $120,000.00. Only in the event that the Contractor commits a major breach,
as defined in section 11.1 of this contract, shall the contractor be required to pay the performance
security to the City. The contractor shall be able to obtain and maintain Security Performances in one
of the following methods acceptable to the City.
A. Cash; or
B. An irrevocable letter of credit issued by a financial institution rated at least "A" by Moody's or
Standard and Poor's in a form acceptable to the City Legal Counsel which shall recognize and
accept the contract's requirements for immediate payment of funds to the City upon
determination by the City Legal Counsel that Contractor is in major breach and that the nature
of the breach is such that the public health and safety are immediately and seriously
endangered, and recognizing that any legal dispute by the Contractor or the creditor shall be
initiated and resolved only after release of the performance security funds to the City; or
C. An irrevocable guaranty issued by an entity rated at least "A" by Moody's or Standard and
Poor's in a form acceptable to the City Legal Counsel which shall recognize and accept the
contract's requirements for immediate payment of funds to the City upon determination by City
Legal Counsel that Contractor is in major breach and that the nature of the breach is such that
--- ---- -- _----_._ --------------------_._.__._----- ---_ --��.—__..._--- ---- -Page 17
the public health and safety are immediately and seriously endangered, and recognizing that
any legal dispute by the Contractor or the creditor shall be initiated and resolved only after
release of the performance security funds to the City; or
D. A surety bond issued by an insurance company rated at least "A" by Moody's, Standard and
Poor's or A.M. Best in a form acceptable to City Legal Counsel which shall recognize and
accept the contract's requirements for immediate payment of funds to the City upon
determination by the City Legal Counsel that Contractor is in major breach and that the nature
of the breach is such that the public health and safety are immediate and seriously endangered,
and recognizing that any legal dispute by the Contractor or the creditor shall be initiated and
resolved only after release of the performance security funds to the City; or
E. Such other forms of security, or a combination of the above methods, that is acceptable to the
city.
F. The irrevocable letter of credit, irrevocable guaranty, or surety bond furnished by the Contractor
in fulfillment of this requirement shall provide that such letter of credit, guaranty, or bond shall
not be cancelled for any reason except upon thirty (30) calendar days' written notice to the City
of the intention to cancel said letter of credit, guarantee, or bond. The Contractor shall, not later
than twenty (20) days following the commencement of the thirty -day notice period, provide the
City with replacement security in a form acceptable to the City. In the event that the
guarantor/surety is placed into liquidation or conservatorship proceedings, Contractor shall
provide replacement security acceptable to the City within twenty (20) days of such occurrence.
9.2 Insurance
Contractor, at its sole cost and expense, for the full term of this Agreement (and any extensions
thereof), shall obtain and maintain at minimum compliance with all of the following insurance
coverage(s) and requirements. Such insurance shall be in a form or format acceptable to City Counsel
and City Risk Management and shall be primary coverage as respects City.
A. Tvoes of Insurance and Minimum Limits:
Worker's Comte nsation -- Statutory Worker's Compensation Insurance shall cover all
Contractor's staff while performing any work incidental to the performance of this
Agreement.
2. General Liability — Commercial general liability insurance policy, including automobile
coverage, in a form acceptable to the City, of not less than $2,000,000 per occurrence
for bodily injury or death, and $2,000,000 per occurrence for loss or damage to property;
and $4,000,000 aggregate.
All policies of insurance required in this Agreement shall be issued by insurance
companies licensed to do business in the State of Montana. Proof of coverage shall be
evidenced by submitting an insurance certificate, or certificates, to the City, which names
the City as an additional insured and indicates that the City will be notified no less than
thirty (30) days prior to alteration, cancellation, termination, or non -renewal of coverage.
____..� _--------- - - ---- � Page 18
3. Professional Liability — Professional Liability insurance policy of not less than $2.000,000
per occurrence and $4,000,000 aggregate.
9.3 Indemnification
A. Contractor agrees to defend, indemnify, protect and hold the City, its officers, employees
and agents harmless from and against any and all claims asserted, or liability established for
injuries or damages to any person or property (including attorney's fees and costs), or
losses and causes of action which may arise from or in connection with the performance by
the Contractor under this Agreement_
B. The City agrees to defend, indemnify, protect and hold the contractor, its officers,
employees, shareholders and agents harmless from and against any and all claims
asserted, or liability established for injuries or damages to any person or property (including
attorneys' fees and costs), or losses and causes of action which may arise from or in
connection with the performance by the City under this Agreement.
SECTION 10 — FISCAL REQUIREMENTS
10.1 Annual Subsidy
The City is not required to provide any subsidy to the Contractor/Subcontractor(s) for the purpose of
this Agreement.
10.2 General Provisions
A. As compensation for services, labor, supplies, and materials furnished under this Agreement,
Contractor shall collect revenues as permitted in this section.
B. All contractors' accounting records shall be in accordance with Generally Accepted Accounting
Principles.
C. Fiscal year for reporting purposes of this Contract will be .January 1, through December 31.
10.3 Billing and Collections
A. Rates — The Contractor's rates beginning at contract start date are located in Exhibit D.
Contractor agrees to bill all transports and medical care without discount of City approved rates
except as required by Medicare, Medicaid and other government agencies. After the Contractor
has exercised its best efforts at full recovery of accounts receivable, it shall negotiate its best
recovery possible from self -pay patients through its collections agency services and for exercise
its ability to "write off" the ambulance fees for self pay individuals who can't or won't pay for
ambulance services.
B. Rate Adjustment — Contractor may increase its rates above the annual GPI increase as required
to maintain financial stability throughout the contract. Any increases to rates above the annual
CPI increase shall be established in accordance with requirements in, Official Code of The City
of Great Falls (OCCGF), Section 8.9.375.
_._.. _.._ gage 19
C. CPI Increase -- Notwithstanding any other provision hereof, Contractor's rates in any given year
shall be increased automatically based on the Annual Western Region Urban Consumer Price
Index (CPI) for the previous calendar year. This increase shall be concurrent with the City's CPI
increase set forth in paragraph 10.6E, hereof.
D. Exchange of Information — By providing the City with ambulance services under the provisions
of Mont. Code Ann. §7-34-103 and pursuant to the terms of this Contract, Contractor may be
provided with patient insurance information (to the extent such information is in the City's
possession or control) in order to ascertain proof of financial responsibility for Contractor's
services, or as allowed by Montana law. Any information obtained by Contractor in this regard
shall be for its confidential use, and shall not be otherwise disseminated. Contractor assumes
responsibility for the security of said information.
10.4 Reporting Responsibilities
During the term of this Agreement, Contractor shall provide the documents and reports shown in
Exhibit A.
10.5 Damages
A. Contractor shall be liable for the damages shown in Exhibit B.
B. Payment Methodology — City will make final damages determination and invoice the Contractor.
Contractor shall pay City monthly for any damages upon receipt and acceptance by the City of
performance reports with damages for the previous calendar month.
C. Damages Disputes — If Contractor disputes City's response time calculation, the imposition of
any other damages, or other conflict arises under this Agreement, the parties will use the
conflict resolution procedure set forth in OCCGF Section 8.9.345.
D. Use of Damages Monies --- Damage monies shall be expended in a manner that benefits the
EMS system as determined by the sole discretion of the City. The EMS System Administrator
may seek recommendations from the Contractor, EMS Advisory Board, and other EMS system
participants or committees.
10.6 Compensation to City
A. Dispatch Services — Contractor shall pay the City for emergency medical dispatch services in
the amount set forth in Exhibit C attached. The Contractor will be responsible for paying the
City on time for each payment on a quarterly basis in April, July, October and January (see
Exhibit C) of each year of the contract term, unless at the direction of the City Commission the
compensation for EMS dispatch services is increased to meet the demands of an enhanced
dispatch center. Ambulance rates may need to be increased with the City Commission's
approval to meet additional compensation requirements. It is the responsibility of the
Contractor to begin payments April 1, 2014. A late payment charge of five (5) percent of any
unpaid balance will'be assessed for each 30-day period or part thereof, in which a payment is
past due. The Cascade County Consolidated Dispatch Center and the City warrants that the
foregoing amount is not greater than its actual costs of providing such services.
Page 20
B. Oversiaht and Monitoring — Contractor will pay the City the amount set forth in Exhibit C
attached for City staff for services rendered to provide ongoing contract oversight and to ensure
Contractor and Subcontractor provides quality medical care. The Contractor will be responsible
for paying the City on time for each payment on a quarterly basis in April, .July, October and
January (see Exhibit C) of each year of the contract term. It is the responsibility of the
Contractor to begin payments, April 1, 2014. A late payment charge of five (5) percent of any
unpaid balance will be assessed for each 30-day period or part thereof, in which a payment is
past due.
C. Medical Direction — Contractor will pay the City the amount set forth in Exhibit C attached for
the provision of EMS 911 system medical direction in the form of a part-time EMS 911 System
Medical Director position. The Contractor will be responsible for paying the City on time for
each payment on a quarterly basis in April, July, October and January (see Exhibit C) of each
year of the contract term. It is the responsibility of the Contractor to begin payments, April 1,
2014. A late payment charge of five (5) percent of any unpaid balance will be assessed for
each 30-day period or part thereof, in which a payment is past due.
D. Arranging for and Providing Pre -Transport Service Fee Contractor will pay the City the amount
set forth in exhibit C attached for City staff arranging for and providing Pre -transport services at
the scene of an emergency medical incident in which the Contractor's employees respond. The
City allows the Contractor to bill the patient and their third party insurance companies for the
services and supplies provided by the City's EMS Services. The Contractor will be responsible
for paying the City on time for each payment on a quarterly basis in April, July, October, and
January (see Exhibit C) of each year of the contract term, It is the responsibility of the
Contractor to begin payments, April 1, 2014. A late payment charge of five (5) percent of any
unpaid balance will be assessed for each 30-day period or part thereof, in which a payment is
past due-
E. Annual fees — The annual fees, as noted in section 10.5 A through ❑, shall be increased
automatically based on the Annual Western Region Urban Consumer Price Index (CPI) for the
previous calendar year.
SECTION 11 — GENERAL CONTRACT REQUIREMENTS
11.1 Contract Termination
Termination— Contractor may terminate this Agreement for no cause by first providing a written notice
to City at least six (6) months prior to the termination date, without the termination being considered a
breach. City may terminate this Agreement at any time for cause for a major breach of its provisions
immediately and seriously affecting the public health and safety, consistent with the provisions herein.
A. "Maior Breach" shall include:
1. Failure of Contractor to operate its ambulances and emergency medical services
program in a manner which enables the City and Contractor to remain in substantial
compliance with the requirements of federal, state, and local laws, rules and regulations.
Contractor shall have 30 days from receipt of notice of breach to cure such failure.
page 21
2. Willful and deliberate falsification of information supplied to the City by the Contractor
regarding its ambulance and emergency medical services program and services,
including, but not limited to, dispatch data, patient reporting data, and response time
performance data, as it relates to the contract.
3. Failure to comply with the response time standard in section 4.1 B. for two consecutive
months, or for any three months in a calendar year, shall be a "Minor Breach" of this
Agreement. Failure to comply with these response time performance requirements for
three consecutive months, or for any four months in a calendar year, shall be a "Major
Breach" of this Agreement.
4. Failure to consistently meet or exceed the various clinical and staffing standards required
herein (as referred to in 5.1 A)
5. Chronic Failure to maintain equipment or vehicles in accordance with good maintenance
practices, or to replace equipment or vehicles in accordance with Contractor's submitted
and accepted Equipment Replacement Policy, except as extended use of such
equipment is approved by the City as provided for herein provided Contractor shall have
30 days from the receipt of notice of such failure.
6. Chronic or persistent failure to comply with conditions stipulated by the City to correct
any "Minor Breach" conditions;
7. Failure of the Contractor to cooperate and assist the City in the investigation or
correction of any "Minor or Major Breach" of the terms of this Agreement; After written
notice by the System Administrator
8. Failure to assist in the orderly transition, or scaling down of services, during the transition
to the next contractor if such contract does not include the Contractor;
9. Failure to maintain in force throughout the term of this Agreement, including any
extensions thereof, the insurance coverage required herein;
10. Failure to maintain in force throughout the term of this Agreement, including any
extensions thereof, the performance security requirements as specified herein;
11. Any other willful acts or omissions of the Contractor that immediately and seriously
endangers the public health and safety.
12. Failure to cooperate and follow the direction of the EMS 911 System Medical Director as
it relates to plans, policies, and medical standards.
13. If contractor (1) admits in writing its inability to pay its debts generally as they become
due, or (11) files a petition to be adjudicated a voluntary bankrupt in bankruptcy or a
similar petition under any insolvency act, or (III) makes an assignment for the benefit of
its creditors, or (IV) consents to the appointment of a receiver of itself or of the whole or
any substantial part of its property.
_� Page 22
14. If Contractor fails to provide the city, with a minimum of 5 months' notice, in writing, that
contractor will be discontinuing ambulance operations in the city.
B. "Minor Breaches" shall be defined to mean failure to fulfill any of the terms and conditions of this
Agreement for which failures are not already provided for and which failures do not amount to a
Major Breach of this Agreement, as that term is defined above. Before such minor breaches
are imposed, Contractor shall be given notice by certified mail or hand delivery, of the alleged
breach and thirty (30) calendar days to cure the breach or to appeal to the EMS System
Administrator.
1. Chronic or persistent failure of the Contractor's employees to conduct themselves in a
professional and courteous manner where reasonable remedial action has not been
taken by the Contractor;
2. Failure to participate in the established Continuous Quality Improvement (CQ1) program
of the EMS Advisory Board, including, but not limited to investigation of incidents and
implementing prescribed corrective actions;
3. Failure to comply with required payment of damages within 30 days written notice of the
imposition of such damage assessment.
11.2 Declaration of Major Breach and Takeover/Replacement Service
If the City determines that a Major Breach has occurred, and if the nature of the breach is, in the City's
opinion, such that public health and safety are endangered, and after Contractor has been given
written notice and 30 days to correct such deficiency, Contractor shall cooperate completely and
immediately with the City to effect a prompt and orderly takeover or replacement by the City of
Contractor's City of Great Falls operations.
If requested by the City, the Contractor shall lease up to three ambulances and equipment in Great
Falls, for a term not to exceed 180 days at fair market value in mitigation of any damages to the City,
resulting from Contractor's breach or failure to perform. However, during the City's takeover of the
ambulances and equipment, the City and the Contractor will be considered lessee and lessor,
respectively.
11.3 Dispute After Takeover/Replacement
Contractor shall not be prohibited from disputing any finding of major breach through litigation,
provided, however, that such litigation shall not have the effect of delaying, in any way, the immediate
takeover/ replacement of operations by City. Neither shall such dispute by Contractor delay City's
access to Contractor's performance security in accordance with Section 9.1 herein.
Any legal dispute concerning a finding of breach shall be initiated only after the emergency
takeover/replacement has been completed. Contractor's cooperation with, and full support of, such
emergency takeover/ replacement process, as well as the immediate release of performance security
funds to City, in accordance with section 9.1 herein, shall not be construed as acceptance by
Contractor of the finding of major breach, and shall not in any way jeopardize Contractor's right to
Page 23
recover any and all damages, including reimbursement of the performance security and any other
costs or other expenses incurred as a result of the takeover or replacement should a court later
determine that the declaration of major breach was in error. However, failure on the part of Contractor
to cooperate fully with City to effect a safe and orderly takeover/replacement of services shall
constitute a major breach under this ordinance, even if it is later determined that the original
declaration of major breach was made in error.
11.4 Breach Not Dangerous to Public Health and Safet
If the City declares the Contractorto be in breach on grounds other than performance deficiencies
dangerous to public health and safety, the Contractor may dispute the City's claim of major breach
prior to takeoverlreplace ment of the Contractor's operations by the City.
11.5 Liquidated Damages
The unique nature of the services that are the subject of this Agreement requires that, in the event of
major default of a type, that endangers the public health and safety, the City must restore services
immediately, and the Contractor must cooperate fully to effect the most orderly possible
takeover/replacement of operations. In the event of such a takeover/replacement of the Contractor's
operations by the City, it would be difficult or impossible to distinguish the cost to the City of effecting
the takeoverlreplace ment, the cost of correcting the default, the excess operating cost to the City
during an interim period, and the cost of recruiting a replacement Contractor from the normal cost to
the City that would have occurred even if the default had not occurred. Similarly, if
takeover/replacement costs and interim operating costs are high, it would be impossible to determine
the extent to which such higher costs were the result of the Contractor's default or from faulty
management of the City's costs during takeover and interim operations.
For these reasons, this liquidated damages provision is a fair and necessary part of this Agreement.
The minimum amount of these additional costs to the City (e.g., costs in excess of those that would
have been incurred by City if the default had not occurred) would be not less than the amount
identified in the performance security requirement of this Agreement even assuming City's
takeoverlreplace ment management team is fully competent to manage the previously contracted
functions.
Therefore, in the event of such a declared major breach and takeover/replacement by the City of
Contractor's services, Contractor shall pay the City liquidated damages in the amount of $120,000.00
under the performance security required by this agreement.
11.6 City Responsibilities
In the event of termination of this Agreement, the City shall be responsible for complying with all laws,
if any, respecting reduction or termination of pre -hospital medical services.
11.7 "Lame Duck" Provisions
If the Contractor fails to win the bid in a subsequent bid cycle, the City shall depend upon the
Contractor to continue provision of all services required under this agreement until the winning
contractor takes over operations. Under these circumstances, the Contractor would, for a period of
Page 24
several months, serve as a "lame duck". To ensure continued performance fully consistent with the
requirements of this agreement throughout any such "lame duck" period, the following provisions shall
apply:
A. Throughout such "lame duck" period, Contractor shall continue all operations and support
services at substantially the same levels of effort and performance as were in effect prior to the
award of the subsequent agreement to the subsequent winning contractor;
B. Contractor shall make no changes in methods of operation that could reasonably be considered
aimed at cutting Contractor's service and operating costs to maximize profits during the final
stages of this contract; and
C. Contractor may reasonably begin to prepare for transition of service to the new Contractor
during the "lame duck" period, and the City shall not unreasonably withhold its approval of the
outgoing Contractor's requests to begin an orderly transition process, including reasonable
plans to relocate staff, scale down certain inventory items, etc., so long as such transition
activities do not impair Contractor's performance during such "lame duck" period, and so long
as such transition activities are prior -approved by the City.
11.8 Equal Employment Opportunity
The Contractor is responsible for complying with and developing equal opportunity policies and
procedures as required by State and Federal guidelines.
11.9 Independent Contractor Status
Contractor is an independent contractor and not an employee of the City. Contractor is responsible for
all insurance (workers compensation, unemployment, etc.) and all payroll related taxes for its
employees. Contractor is not entitled to any employee benefits. City agrees that Contractor shall
have the right to control the manner and means of accomplishing the result contracted for herein.
By their signatures to this Contract, each party certifies that it is his or her considered judgment that
the Contractor engaged under this Contract is in fact an independent contractor.
11.18 Non -Assignment and Non -Delegation
Contractor shall not assign or delegate this Agreement without the prior written consent of City, which
consent shall not be unreasonably withheld.
11.11 Conformance to Regulations
Contractor shall perform this Agreement in conformance with all applicable Federal, State and local
rules and regulations, including applicable facility and professional licensure and/or certification laws.
11.12 Conformance to Law
This Agreement shall be construed and interpreted according to the laws of the State of Montana, the
United States of America, and the ordinances of the County of Cascade and the City of Great Falls.
Page 25
11. 13 Reports
The Contractor shall submit written reports of operations, and other reports as requested by City
according to the table shown in Exhibit A. The format for the content of such reports will be developed
by the City in consultation with the Contractor.
11.14 Changes
The City may from time to time request changes in the scope of the services of the Contractor to be
performed hereunder. Such changes, which are mutually agreed upon between the City and
Contractor, shall be effective when incorporated in written amendments in this Agreement. No
alteration, amendment, or modification of the terms of this Agreement shall be valid unless executed
by written amendment hereto, signed by both parties and approved by the City.
Amendments or modifications to the provisions of this Agreement, including its term, may be initiated
by either party and may be incorporated into this Agreement if it is in writing and approved by the
parties.
11.15 Retention of Records. Record Keepina. and Accountinai Practices
Contractor shall retain records pertinent to this Agreement for a period of not less than three (3) years
after termination of this Agreement. All accounting records shall be kept in accordance with Generally
Accepted Accounting Principles. Annually the Contractor shall submit an "Agreed upon Procedures
Engagement" Letter from an independent accounting firm complying with GAAP standards.
Any documents provided to the City by the Contractor may be subject to public inspection under
Montana law. If a records request for Contractor's information is made, City will notify Contractor of
such request. If Contractor intends to claim that any such requested documentation is confidential
proprietary, or trade secret information as identified in Mont. Code Ann. §30-14-402, or otherwise
under applicable law, it will be required to take any and all steps necessary, including court action, to
establish that the information is not subject to public disclosure.
11.16 Force Maieure
Contractor shall not be liable to the City for delays in performing the services contemplated under this
agreement or for the indirect cost resulting from such delays that may result from formally declared
riots, war, disasters, extraordinary weather conditions or other natural catastrophe, or any other cause
beyond the reasonable control or contemplation of either party which directly affects the Contract
Service Area described in 1.4, above.
11.17 Severability
In the event that any one or more of the provisions contained in this Agreement shall for any reason be
made illegal by any Federal or State statute or regulation or held by any court or by the Office of
Inspector General (DIG) of the United States Department of Health and Human Services to be invalid,
illegal, or unenforceable in any respect, such invalidity, illegality, or unenforceable shall not affect any
other provisions and the Agreement shall be construed as if such invalid, illegal, or unenforceable
provision had never been contained in it.
Page 26
IN WITNESS WHEREOF, the parties have executed this Agreement as follows;
CITY OF GREAT FALLS
Gregory T. Doyon, City Manager
ATTEST:
REVIEWED FOR LEGAL CONTENT
Lisd Kunz, City Ierk
44
t
Sara R. Saxe, City Attorney
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Page 27
GREAT FALLS EMERGENCY SERVICES, Inc.
STATE OF MONTANA
County of Cascade : ss.
City of Great Fails
On this day ofy, � _ , 2014, before me, a Notary Public to and for the State
of Montana, personally appeared baLja known to fne to be the person whose name is
subscribed to the foregoing instrument and acknowledged to me that he shelthey) executed the
same.
IN WITNESS THEREOF, I have hereunto set my hand and affixed my official seal the day and
year in this certificate first above written.
Notary Public for the State of Montana
(NOTARIAL SEAL) Printed Name:
Residing at Great Falls, Montana.
My Commission Expires: .
Zh
ftwe of own""
SEAL R rt owrt fa, swam
Page 28
SECTION 12 — EXHIBITS
Exhibit A: Reporting Requirements
Exhibit B: Damages
Exhibit C: Quarterly Payment Schedule
Exhibit ❑: Ambulance Rates
Exhibit E: Response Zone Map
Exhibit F:
Non -Emergent Response Damages
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Page 29
Exhibit A: Reporting Requirements
Initial Reporting Requirements
Report Name
Due Date
Responsible
Submit To
Deployment Plan
Jan. 1, 2014
Contractor
Contract Administrator
EMS Personnel Roster (including
information required in 8.9.335 (H)j
Jan. 1, 2014
Contractor
Contract Administrator
Hierarchal table of organization
identifying the management positions
and their roles and responsibilities
Jan. 1, 2014
Contractor
Contract Administrator
Vehicle Inventory
Jan. 1, 2014
Contractor
Contract Administrator
Equipment and Vehicle Replacement
Policy
Jan. 1, 2014
Contractor
Contract Administrator
Ongoing Reporting Requirements
Report Name
Due Date
Frequency
Responsible
Submit To
Deployment Plan
30 days prior to change
As Needed
Contractor
Contract
changes
unless emergency adjustment
Administrator
or adding units
Updated deployment
Annually
Contractor
Contract
maps
Administrator
Response Time
On the 1 oth of each month for
Monthly
Contract
Contractor
Performance Report
the previous month
Administrator
Response Time
By the 20th of each month for
Monthly
Contractor
Contract
Exemption Request
the previous month
Administrator
Notification of major
Within 10 business days of
As Needed
Contractor
Contract
regulatory actions or
notification by a governmental
Administrator
sanctions
agency
Ongoing Reporting Requirements
Page 30
Report Name
Due Date
Frequency
Responsible
Submit To
Notification of any
Within 10 business days of
As Needed
Contractor
Contract
major enforcement
notification
Administrator
actions, and of any
litigation or other legal
or regulatory
proceeding
Vehicle List Changes
As Needed
Contractor
Contract
Administrator
Records of Vehicle
Within 5 business days of a
Annually
Contractor
Contract
maintenance
written request from the City
Administrator
Vehicle and equipment
Within 3 business days of
As Needed
Contractor
Contract
failure reports
written request from the City
Administrator
Number of emergency
Monthly
Contractor
Contract
responses and
Administrator
transports
Incidents in which
Within 2 business days of
As Needed
Contractor
Contract
Contractor's personnel
notification
Administrator
fail to comply with
protocols and/or
contractual
requirements
Complete listing of all
As Needed
Contractor
Contract
written service
Administrator
complaints received
and their
disposition/resolute
Agreed upon
120 after the close of the
Annually Contractor Contract
Procedures
Contractor's fiscal year
Administrator
Engagement Letter
from an independent
accounting firm
according to section
11.15 herein
Ongoing Reporting Requirements
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Page 31
Report Name
Due Date
Frequency
Responsible
Submit To
Response to City
Within 5 business days of a
As Needed
Contractor
Contract
inquiries about service
written request from the City
Administrator
anchor complaints
Violations of the
Immediately upon notification
As Needed
Contractor
Contract
Administrative Rules of
from a government agency
Administrator
Montana Title 37 —
Department of Public
Health and Human
Services, Chapter 104
or Montana Code
Annotated Title 50 —
Health and Safety,
Chapter 6 —
Emergency Medical
Services.
Page 32
Exhibit B: Damages
Damages for Failure to Meet Resganse Time Standard
The Contractor shall pay the City $10.00 per minute for each call that does not meet the response time
standard (limit per applicable call to be $100.00). These damages would be assessed on an individual
call basis to begin at 12 minutes and 01 seconds for the urban area, 15 minutes and 01 seconds for
the rural areas and 23 minutes and 01 seconds for super rural areas. Each response time infraction
as noted above will be weighed against the primary response times according to section 4.1, B. (See
Chart-1) Response time exemption will apply according to section 4.1, C.
URBAN RURAL SUPER RURAL
12.01-13:00
$30.00
13:01-14:00
$40.00
14:01-15:00
$50.00
15:01-16:00
$60.00
16:01-17:00
$70.00
17:01-18:00
$80.00
18:01-19:00
$90.00
19:01-20:00
$100.00
15:01-16:00
$30.00
16:01-17:00
$40.00
17:01-18:00
$50.00
18:01-19:00
$60.00
19:01-20:00
$70.00
20:01-21:00
$80.00
21:01-22:00
$90.00
22:01-22:00
$100.00
23:01-24:00
$30.00
24:01-25:00
$40.00
25:01-26:00
$50.00
26:01-27:00
$60.00
27:01-28:00
$70.00
28:01-29:00
$80.00
29:01-30:00
$90.00
30:01-31:00
$100.00
Damages for Failure to Respond to 911 Emergency Incidents
In the event the Contractor fails to respond to, or is unable to respond within 20 minutes of initial
dispatch, when the City transports pursuant to an emergency medical request, the Contractor shall pay
the City $500.00 damages per incident. Damages for the 4th and subsequent calls will not be
imposed when three (3) calls have already been dispatched in any given rolling 20 minute interval. The
damages referred to herein are in lieu of, and not in addition to, any other response time damages
referred to herein.
Da mactes for Failure to Co P ly with Code III S peed Limits
Contractor shall pay the City $250.00 for each incident that is verified and documented, in which the
Contractor's personnel exceed the posted speed limit by more than 10 miles per hour when
responding to a code III call.
Damages for Failure to Meet Ambulance Staffing or Clinical Standards
Contractor shall pay City $250.00 whenever an ambulance not staffed as required in this Agreement
responds to an emergency medical request, except in a declared MCI or disaster situation. Within 72
Page 33
hours of discovery, Contractor shall provide the Contract Administrator with a full description of each
response where there was a failure to meet ambulance clinical or staffing standards and the remedial
action taken to prevent a reoccurrence.
Damages for Failure to Provide Data to Determine Compliance
Each time an ambulance is dispatched and the ambulance crew fails to report on -scene time without a
valid reason; Contractor shall pay City $50.00. When on -scene time cannot be provided, unless a valid
reason is provided, response time for that call shall be deemed to have exceeded the required
response time for purposes of determining response time compliance. In order to rectify the failure to
report an on -scene time and to avoid the damage, Contractor may demonstrate to the satisfaction of
the City an accurate on -scene time.
Failure to comply with the EMS 911 System Medical Director's _Orders and Protocols
Chronic failure on part of the Contractor to follow EMS protocols and orders given by the EMS 911
System Medical Director the Contractor shall pay the City $150.00. The EMS 911 System Medical
Director shall provide a written report to the EMS System Administrator explaining the infraction and a
brief description of corrective actions and plans for improvement on the part of the Contractor.
Minor Breach
The City may impose damages not to exceed one hundred dollars ($100.00) for each breach that
constitutes a "Minor Breach" of the contract and that has not been cured within 30 days, and for a
mutually agreed upon time frame by both parties, from date of official notice being given by the City or
designee.
"Minor Breaches" shall be defined as failure to fulfill any of the terms and conditions of this Agreement
which do not amount to a "Major Breach."
Before damages for Minor Breach are imposed, the Contract Administrator, or designee, shall give the
Contractor written notice of the alleged Minor Breach and opportunity to cure the breach or otherwise
respond to the allegations of breach.
_Monthly Response Time Compliance
Each month that the Contractor does not comply with the response time requirement in each response
zone at the 90% mark, Contractor shall pay the City $100.00 for each tenth (0.1) of a percentage point
below 90%. A response zone must have a minimum of one hundred (100) EMS responses for this
performance standard to apply.
The EMS System Administrator has the authority to waive damages when it is in the best interest of
the EMS system.
Page 34
Exhibit C: Quarterly Payment Schedule
Description of Service
Annual Amount
Quarterly Payment
Dispatch Services from CCCDC
$25,842.85
$6,460.71
EMS System Oversight and Monitoring
$ 9,897.25
$2,474.31
EMS 911 System Medical Director
$ 7,917.81
$1,979.45
Pre -Transport Service Fee
$ 21,993.92
$5,498.47
Totals
$65,651.83
$16,412.94
Notes:
1 Annual amount will be increased according to the CPI provisions detailed in the contract.
2 Quarterly payments to the City are due on the first day of the new quarter, April 1, July 1, October 1,
and January 1.
Page 3S
Exhibit D: Ambulance Rates
Advanced Life Support Cost
ALS Emergency $1059.03
ALS 2 Emergency $1059.03
Waiting Time
No Charge for 911 (typical S 10425 every 15 min)
Night Charge
No Charge (typical S100-$300)
ALS Treatment w/o Transport
$100
Oxygen
$ 73.82
I.V. Supplies
$ 62.67
ALS Routine Supplies
$ 84.49
Intubations Supplies
$ 90.29
Defibrillation Supplies
$ 73.29
EKG Supplies
$ 13.28
Mileage (per loaded niile)
$ 20.98
Medications are in addition to ALS and ALS2 charges
Basic Life Support
Cost
BLS Emergency
$901.82
Night Charge
No Charge (typical $1004300)
BLS Treatment w/o Transport
$50
Waiting Time
No Charge for 911 (typical $10-$25 every 15 min)
Oxygen
$ 73.82
BLS Routine Supplies
$ 63.21
EKG Supplies
$ 13.28
Mileage (per loaded mile)
$ 20.98
Standby (one hour minimum)
$75.00 per hour, not to be duplicated with ALS or BLS
charges.
Standby (each additional 15 minutes
$18.00
If you have any questions regarding your ambulance charges or our reinibursenient rates, contact the GFES Manager at
406-453-5300 to discuss. Thank you.
Page 36
Exhibit E: Response Zone Ma
Response Zone Maps on File and available on request;
City of Great Falls
Fire Station-1,
105 9th Street South,
Great Falls Mt
Phone Number: (406) 727-8070
Page 37
Exhibit F, Non -Emergent Response Damages
NON -EMERGENT DAMAGES TIMES
18:01-19:00
$30.00
19:01-20:00
$40.00
20:01-21:00
$50.00
21:01-22:00
$60.00
22:01-23:00
$70.00
23:01-24:00
$80.00
24:01-25:00
$90.00
25:01-26:00
$100.00
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Page 38