Board approves interim rate increase for medical-transport calls, directs RFP after debate over response-time penalties

The Orange County Board of Supervisors voted to approve a short‑term increase in reimbursement rates for medical‑transportation providers responding to 5150 psychiatric holds and directed the county's Health Care Agency to issue a request for proposals within 90 days for a longer‑term contract.

Vice Chair Doe moved the staff recommendation to approve the amendment; Supervisor Bartlett seconded. After a lengthy debate about incentive structure, penalties and service continuity, the motion passed 4‑1. Several supervisors said the increase is intended to reduce previously reported average wait times of two to four hours for adults and three to seven hours for children on certain calls.

Supervisor Nelson pressed staff to tie the higher rate to concrete response standards and to include objective criteria to remove consistently nonperforming vendors from the rotation. "Pay them what you ask, but you do have to respond within the time period," Nelson said, urging a clear numeric threshold so vendors know the consequences for repeated failures. Richard Sanchez of the Health Care Agency said penalties for missed time requirements are included in the proposed amendment and that providers can be dropped from the rotation for persistent nonresponsiveness; he said the agency intended to use an RFP process to build more detailed enforcement language similar to the county's 911 contracts.

Supervisor Do and other board members emphasized the need for interim financial incentives to get faster pickups now, while the RFP is developed. The board asked staff to return with a schedule defining how many missed calls would trigger removal and to ensure coverage remains for 911 calls and geographic areas.

The approval is an interim step; HCA told the board it expects to issue an RFP by October and will monitor response times under the new rates.

No contract award was finalized beyond the amendment approved at the meeting; staff will report back on performance metrics, the RFP timeline and specific penalty thresholds.