Baker County staff review ambulance service area plan; ordinance changes on backup providers and nonemergency transport remain in work session

County staff presented a revised Ambulance Service Area plan and draft ordinance updates to the Baker County Board of Commissioners, explaining changes requested by the Oregon Health Authority (OHA) and new language to allow backup emergency coverage through contracts between the assigned emergency provider and a licensed subcontractor.

The presentation, delivered by county staff, said OHA provided a “further development required” letter with required and recommended edits. The draft plan was reorganized so required items appear before recommendations, staff said, and the plan explicitly adds a first‑right‑of‑refusal provision for interfacility transfers and nonemergency transfers where the hospital determines transfer is necessary.

The county staff emphasized the plan was always intended to cover prehospital care rather than hospital internal transfer policy. Staff said the plan now includes an Excel monitoring spreadsheet Pioneer (the assigned emergency provider) will use to report provider notification times, response times and patient care metrics and that an ambulance advisory committee will review compliance data quarterly.

Staff read a new paragraph added to the ASA plan that would allow the assigned emergency transport provider to contract with a licensed ambulance provider to provide backup emergency coverage within the assigned ASA, provided those subcontracted providers meet the same standards and quality assurance requirements contained in the agreement between Baker County and the assigned provider. The draft language states the county would not contract directly with those subcontractors and that any quality problems would be addressed through the assigned provider or, if necessary, through licensing actions by the Oregon Health Authority.

County staff told commissioners that allowing subcontracting is intended to let Pioneer meet staffing and coverage obligations without the county having to run a separate RFP for a backup provider. "The assigned emergency transport provider may contract with a licensed ambulance provider to provide backup emergency coverage ... Such contract must meet the same standards and requirements as outlined in the agreement between Baker County and the assigned emergency provider," staff read from the draft (page 24), noting the subcontractor relationship would be between Pioneer and the subcontractor, not the county.

Staff also discussed proposed ordinance edits to tighten county oversight of nonemergency transport operators. The draft ordinance would require written authorization for nonemergency transport providers to operate in the county and gives the county a role in tracking and authorizing those providers. Staff said the ordinance changes and the plan’s backup‑provider language are linked to a letter the county may send supporting Baker City’s application for an ambulance license; that letter will need to reflect coordination with Pioneer.

OHA items flagged as "required" included clarifications around which transfers the ASA covers and documentation of monitoring and sanctions. Staff said sanctions for noncompliant personnel or providers will be coordinated with medical directors and, where licensing issues arise, referred to OHA for action. The mass casualty appendix (Appendix H) was added as a placeholder directing users to contact county emergency management for field‑level procedures.

Commissioners and staff discussed logistics: signature pages for mutual aid agreements were separated into their own pages so partner agencies can sign without circulating the entire ASA packet; Appendix B (current emergency response transport assignments) was updated to 2024; Appendix C contains separate EMS mutual aid language. Staff said some maps were left as recommendations and not changed until confirmed.

No formal action was taken. Staff and commissioners agreed the ASA committee, the assigned provider and local fire agencies should review changes, that copies of edits must be distributed to all parties who requested them, and that the ASA plan and ordinance will return for a public hearing and first reading after those steps. A county staff member said the packet is not yet ready for a vote: "So it wouldn't be ready to be voted on today," and commissioners asked staff to circulate the revised drafts and prepare the ordinance for first reading in February, with ASA committee review beforehand.

Ending: The board directed staff to continue coordinating with Pioneer, Baker City Fire and the ASA advisory committee, circulate updated documents to stakeholders, and bring the ordinance and plan back for formal public notice and hearing once OHA requirements and local signatures have been addressed.