Amended  IN  Senate  July 13, 2023
Amended  IN  Senate  July 05, 2023
Amended  IN  Senate  July 03, 2023
Amended  IN  Assembly  May 26, 2023
Amended  IN  Assembly  May 01, 2023
Amended  IN  Assembly  April 19, 2023
Amended  IN  Assembly  April 13, 2023
Amended  IN  Assembly  March 16, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill
No. 1168

Introduced by Assembly Member Bennett

February 16, 2023

An act to add Sections 1797.11 and Section 1797.232 to the Health and Safety Code, relating to emergency medical services.


LEGISLATIVE COUNSEL'S DIGEST


AB 1168, as amended, Bennett. Emergency medical services (EMS): prehospital EMS.
Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems and authorizes each county to develop an EMS program and designate a local EMS agency. Existing law requires a county to enter into a written agreement with a city or fire district that contracted for or provided prehospital EMS as of June 1, 1980. Existing law requires, until that written agreement is reached, prehospital EMS to be continued at not less than the existing level and the administration of prehospital EMS by cities and fire districts contracting for or providing those services as of June 1, 1980, to be retained by those cities and fire districts.
This bill would require a city to be treated as if it had retained its authorities regarding, and the administration of, prehospital EMS if specified requirements are met. If a joint powers agreement regarding prehospital EMS was initially executed on or after January 1, 2024, the bill would ensure a city or fire district retains its existing authorities regarding, and the administration of, prehospital EMS. The bill would state the Legislature’s intent to clarify the effect of joint powers agreements regarding prehospital EMS on specified rights, obligations, and authorities, to reduce disruptions to EMS systems, and to abrogate contrary judicial holdings.
Existing law defines “exclusive operating area” as an EMS area or subarea defined by the emergency medical services plan for which a local EMS agency, upon the recommendation of a county, restricts operations to one or more emergency ambulance services or providers, as specified. Existing law authorizes a local EMS agency to create one or more exclusive operating areas in the development of a local plan if a competitive process is utilized to select the provider or providers of the services pursuant to the plan.
This bill would require the local EMS agency, if a city’s assertion of its authorities regarding, and administration of, the prehospital EMS causes a local EMS area to no longer satisfy the requirements for an exclusive operating area as mentioned above, to provide a right of first refusal to the exclusive operating area’s designated provider or providers to continue providing services in a new exclusive operating area composed of the remainder of the local EMS area outside of the city, which would be deemed an exclusive operating area created without a competitive process. The bill would authorize the county to provide prehospital EMS, including emergency ambulance services, as specified, in the remainder of the local EMS area on an exclusive basis if the designated provider or providers decline to continue services. The bill would require a specified city to enter into an agreement with the county to provide prehospital EMS, including emergency ambulance services, within the remainder of the local EMS area on an exclusive basis, as specified, if the county determines that specified options are not economically viable, would reduce the level or quality of care in the remainder of the local EMS area, or are not in the county’s best interests. The bill would require the parties developing contracts pursuant to these provisions to collaborate on response time standards for the local EMS area, and would require those standards to meet or exceed the response time standards previously established by the local EMS agency for that area. By creating new duties for local EMS agencies, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
The bill would become operative only if AB 716 of the 2023–24 Regular Session is enacted and takes effect on or before January 1, 2024.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.Section 1797.11 is added to the Health and Safety Code, to read:
1797.11.

The Legislature finds and declares all of the following:

(a)Local governments’ provision, directly or by contract, administration, and regulation of prehospital emergency medical services (EMS) is a matter of public safety and critical to the public peace, health, and safety of the State of California. Recognizing that the state’s communities have diverse needs and resources, local control over the types, levels, and availability of these services is a longstanding tradition in California that the Legislature intends to retain.

(b)This division is designed to encourage coordination and planning among local governments within county or regional EMS systems in order to achieve the most effective prehospital EMS on a countywide or regionwide basis.

(c)One of the ways in which local governments coordinate, plan, and achieve the most effective countywide or regionwide EMS and leverage their combined resources to carry out their prescribed functions under this division is through agreements for the joint exercise of powers under Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code.

(d)City of Oxnard v. County of Ventura (2021) 71 Cal.App.5th 1010 has created confusion and concern among the state’s local governments regarding the utility and desirability of entering into joint powers arrangements for EMS purposes because the decision held, in part, that a city was ineligible for, and did not have the right to administer emergency ambulance services within its territorial jurisdiction under, Section 1797.201 because the city delegated to a county the administration of those services through a joint exercise of powers agreement, which the parties had entered into nearly a decade before the enactment of this chapter.

(e)In enacting Section 1797.232, it is the intent of the Legislature to clarify the effect of agreements for the joint exercise of powers regarding prehospital EMS under Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code on the rights, obligations, and authorities of counties, local EMS agencies, cities, fire districts, and EMS providers under the EMS act and to preserve the utility and desirability of those agreements for EMS purposes.

(f)This section and Section 1797.232 do not authorize the substantial impairment of contractual obligations of an agreement to provide services within an exclusive operating area under Sections 1797.85 and 1797.224.

SEC. 2.SECTION 1.

 Section 1797.232 is added to the Health and Safety Code, to read:

1797.232.
 (a) Notwithstanding City of Oxnard v. County of Ventura (2021) 71 Cal.App.5th 1010, a city shall be treated as if it had retained its authorities regarding, and administration of, prehospital EMS emergency medical services (EMS) ambulance services within the city’s territorial jurisdiction pursuant to Section 1797.201, only if all of the following requirements are satisfied:
(1) The city became a party to a joint powers agreement regarding ambulance services before the enactment of this chapter.
(2) The joint powers agreement provided a county with the sole authority to contract with ambulance service providers on behalf of the other parties to the joint powers agreement.
(3) On December 17, 2020, the city provided notice of its withdrawal from the joint powers agreement, effective July 1, 2021.
(4) The city ceased to contract for, provide, or administer prehospital EMS ambulance services on or before December 31, 2022.
(b) A joint powers agreement regarding prehospital EMS initially executed on or after January 1, 2024, between a county and a city or fire district, shall not be construed as a “written agreement with the city or fire district regarding the provision of prehospital emergency medical services for that city or fire district” within the meaning of Section 1797.201, and the city or fire district shall retain its existing authorities regarding, and administration of, the prehospital EMS pursuant to Section 1797.201, if any, following entry into the joint powers agreement. The joint powers agreement shall provide terms to address the withdrawal of the city or fire district from the agreement and the effect of a withdrawal on the EMS system and exclusive operating areas, if any.
(c) If a city’s assertion of its authorities regarding, and administration of, the prehospital EMS pursuant to Section 1797.201 under subdivision (a) of this section causes a local EMS area that is currently designated as an exclusive operating area by the local EMS agency to no longer satisfy the requirements for an exclusive operating area under Sections 1797.85 or 1797.224, all of the following shall apply:
(1) The local EMS agency shall provide a right of first refusal to the exclusive operating area’s designated provider or providers to continue providing services in a new exclusive operating area composed of the remainder of the local EMS area outside of the city, which shall be deemed an exclusive operating area created without a competitive process under Sections 1797.85 or 1797.224.
(2) If the designated provider or providers decline to continue services under paragraph (1), the county may provide prehospital EMS, including emergency ambulance services, in the remainder of the local EMS area on an exclusive basis by doing one of the following:
(A) Assigning the duty of providing such services to the county fire department or a separate county department created for those purposes.
(B) Creating a new exclusive operating area, which shall encompass, at minimum, the remainder of the local EMS area, through a competitive process under Section 1797.224. The exclusive operating area shall not include the city specified in subdivision (a), unless that city is selected to be the provider of the exclusive operating area pursuant to the competitive process.
(3) If the county determines that the options in paragraph (2) are not economically viable, would reduce the level or quality of care available in the remainder of the local EMS area, or are not in the county’s best interests, then the city specified in subdivision (a) shall enter an agreement with the county to provide prehospital EMS, including emergency ambulance services, within the remainder of the local EMS area on an exclusive basis consistent with subdivision (e) of Section 14136 of the Welfare and Institutions Code.
(4) In developing contracts pursuant to this subdivision, the contracting parties shall collaborate on response time standards for the local EMS area, which shall meet or exceed the response time standards previously established by the local EMS agency for that area.
(5) Contracts developed pursuant to this subdivision shall include the local EMS agency’s EMS system requirements and the response time standards from paragraph (4).
(6) (A) A contract, or subcontract for emergency ambulance services, developed pursuant to this subdivision shall comply with the requirements of subdivisions (c) and (d) of Section 1797.230 and subdivisions (b), (c), and (d) of Section 1797.231, and, to the extent allowed by law, provide for the recruitment, and preservation of the seniority status, of the incumbent workforce.
(B) If the incumbent workforce is represented by a recognized employee organization or official representative, the contractor shall do both of the following:
(i) Meet with the incumbent workforce’s recognized employee organization or official representative to review and discuss the collective bargaining agreement for the incumbent workforce.
(ii) Request and review any other existing collective bargaining agreements for ambulance service employees in the region.
(C) Prior to the county entering into a contract with the contractor developed pursuant to this subdivision, the contractor shall certify compliance with this paragraph.
(D) For the purposes of this paragraph, “contractor” means the designated provider or providers under paragraph (1), a county fire department or other county department created for these purposes pursuant to subparagraph (A) of paragraph (2), a provider selected to serve a new exclusive operating area consistent with subparagraph (B) of paragraph (2), or the city described in paragraph (3).
(7) If the designated provider or providers decline to continue services under paragraph (1), the city specified in subdivision (a) shall provide services within the local EMS area until the time the county completes the requirements in paragraphs (2) to (5), inclusive, pursuant to the same contractual, permitting, or regulatory terms, conditions, and requirements of the county for that area, except as otherwise agreed to by the county and the city.
(d) For purposes of this section, “joint powers agreement” means an agreement for the joint exercise of powers under Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code.
(e) This section does not affect, modify, limit, or otherwise impair the medical control of the medical director of a local EMS agency granted under this division, including, but not limited to, Chapter 5 (commencing with Section 1798).
(f) This section does not affect, modify, limit, or otherwise impair or enlarge the local EMS agency’s ability to set response time standards for all providers within a local EMS area.

SEC. 3.SEC. 2.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

SEC. 4.SEC. 3.

 This act shall become operative only if Assembly Bill 716 of the 2023–24 Regular Session is enacted and takes effect on or before January 1, 2024.