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A
Notice
that
our
distinguished
treasurer
is
not
here,
do
we
have
anything
from
the
treasurer's
office
that
would
like
to
make
a
report.
Thank
you
morning,
mr
chairman
commissioners.
The
treasurer's
office
has
no
updates
this
week,
just
pretty
much
business
as
usual.
Regular
tax
collections,
accounting
and
balancing
daily
okay
did
I
get
the
numbers
correct.
The
ada
county
gets
four
thousand
nine
hundred
dollars
in
pilt
funds.
A
C
A
A
Second,
even
the
motion-
I
don't
they
ever
say,
hi
motion
carries
next
up.
We
have
interim
agreements
for
expo
idaho.
There's
three
may
have
a
motion
on
the
interim
agreements.
A
Second,
that
you've
heard
the
motion.
Favor,
say:
aye,
aye
carys.
We
next
up.
We
have
the
barber
park,
education
and
event
center
agreements.
We
have
two.
There
do
have
a
motion.
A
B
B
E
A
Okay,
you've
heard
the
motion,
all
those
favors
say:
aye
aye,
aye,
aye.
B
I'm
mike
note,
mr
chair,
yes,
scott
coburg
zone.
I
think
that
for
agreement
number
one
four,
six,
four
one-
we
should
have
a
conversation
this
year
and
look
at
a
possibility
of
going
out
for
rfp.
B
B
B
B
B
Elizabeth
did
you
oh
well
we'll
talk
later
pictures
on
the
leadership
event?
Did
you
find
him?
No,
his
chamber.
B
A
B
A
All
right,
you've
heard
of
motion
almost
favors,
signified
by
saying
aye.
A
Good
morning
today
is
tuesday
april
19th.
The
time
is
9
30.
the
board
of
commissioners
sitting
as
a
board
of
emergency
medical
services.
District
is
in
session
to
conduct
its
weekly
open
business
meeting.
All
three
commissioners
are
present
also
with
us
are,
if
you
can
introduce
yourself
to
the
record.
A
Sean
rayne
paramedics
mark
matson
paramedics
and
we
have
it
guy
and
on
the
bridge
we
have
bethany
bethany
callie,
all
right.
All
three
commissioners
are
present.
Madam
clerk,
are
there
changes
to
the
agenda.
E
B
A
D
D
Commissioners,
I
brought
deputy
chief
john
blake
and
our
integration
officer
mark
babson
down
with
me
to
talk
to
you
guys.
Steve
rutherford
got
a
hold
of
me
last
week
and
with
indigent
services
kind
of
moving
away
from
what
they've
done
in
the
past.
There
are
a
few
budget
items
that
he
asked
me
about.
D
D
How
could
we
care
for
patients
in
a
different
way
than
we
had
in
the
past?
So
the
first
thing
we
did
was
really
went
out
and
did
a
lot
of
stakeholder
engagement.
We
engaged
groups
that
we
interacted
with
on
a
frequent
basis,
but
in
a
different
way
than
we
had
in
the
past
to
figure
out.
How
could
we
benefit?
D
You
know,
programs,
like
you,
know
the
homeless,
shelters,
the
hospital
systems
you
know
and
as
we
started
to
to
reach
out
to
people
we
found
more
and
more
and
mark
is
very
aware
that
we
ended
up
talking
to
a
lot
of
different
people
about.
You
know
how
we
interact
with
ems
and
and
then
how
we
could.
We
could
go
out
and
help
people
not
need
to
call
9-1-1.
D
You
know,
thereby
you
know
reducing
the
amount
of
service
that
we
have
to
provide
to
people
better
service,
better
for
the
taxpayers
and
better
outcomes
for
the
patients.
D
So
in
2011
there
were
eight
people
that
went
through
the
initial
training.
It
was
actually
provided
by
rocky
mountain
college.
Is
that
right
mark
and
we
we
trained
those
eight
people
up
to
the
community
paramedic
level.
We
at
the
time
troy
came
to
the
board
and
got
two
ftes
approved,
and
it
was
four
people,
so
they
split
their
time
24
hours
in
the
field
24
hours
as
a
community
paramedic
doing
that
work.
D
We
had
to
transport
that
patient
to
the
hospital,
even
if
there
was
nothing
wrong
with
them
medically
to
be
cleared
before
they
go
to
the
psych
facility,
and
so
the
idea
was
that
we
would
go
out
and
a
paramedic
would
do
that.
Evaluation
based
on
guidelines
and
protocols
that
the
medical
directors
put
in
place.
You
know
we
would
swab
their
cheek
with
a
swab
that
would
tell
us
if
they
had
any
drugs
in
their
system.
We'd
do
a
breath.
D
B
D
We
actually
respond
with
them,
so
we
respond
to
the
scene,
it's
usually
us
a
police
officer
and
then
the
dme
ends
up
coming
out.
D
D
You
respond
to
suicidal
cold.
I
don't
have
an
exact
number,
but
it's
daily
they're
a
lot
and.
D
G
B
B
And
sat
there
in
the
emergency
room
with
these
folks
agitated
and
psychotic
and
whatnot,
and
sometimes
you
know,
for
hours
and
hours
and
hours
on
end
and
it
just
made
them
more
agitated.
It
seemed
like
yeah.
That's.
D
D
And
even
with
with
the
gross
growth
we've
seen
in
the
valley
on
top
of
covid,
you
know
the
ers
have
been
holding
some
of
these
metal
hold
patients
in
the
er
for
72
plus
hours.
D
You
know
which
that's
terrible,
so
that
was
the
first
pilot
program.
We
did.
We
found
some
success
for
that.
We
moved
that
to
a
permanent
program
when
I
came
into
the
office
in
2013.
Is
that
as
the
deputy
chief
of
operations,
which
is
now
john
blake,
I
I.
D
D
One
of
the
things
that
we
ran
into
is
we
ended
up
with
several
pilot
programs
and,
if
you
think
about
two
ftes
trying
to
split
two
ftes
between
psychiatric
emergency
team
hospital
discharge,
our
normal
field,
referrals
field
referrals,
these
different
types
of
things
that
stretch
this
too
thin,
so
we
just
before
covered
hit.
I
know
they
were
really
looking
at.
D
You
know
and
that's
been
kind
of
a
constant
since
we
started
the
program,
there
isn't
a
lot
of
b
budgets
or
things
that
we
need
for
the
program.
We
do
have
some
supplies
that
we
buy,
but
it's
that's
not
the
expense.
It's
on
the
the
personnel
side,
but
you
know
as
we
as
we
grew
the
the
the
program.
You
know
we
work
closely
with
saint
luke's.
We
entertained
a
grant
with
pacific
source.
D
We
were
really
hopeful
that
that
one
was
going
to
take
hold,
where
the
idea
being
that
we
would
take
these
right,
their
data
that
they
have
identify.
D
We
were
doing
an
ed
discharge
program,
so
there
were
a
lot
of
different
things
we
tried
to
do,
but
they
were
kind
of
the
bread
and
butter
for
the
program
at
that
point
in
time
was
the
psychiatric
emergency
team,
the
field
referrals
that
we
get
from
any
law
enforcement
official,
a
paramedic
or
a
firefighter
that
ident
goes
into
a
person's
house
and,
let's
say
something
as
simple
as
this
person
falls
twice
a
week
and
we
get
called
out
to
just
pick
them
up
and
they're
not
injured,
but
they
realize
this
person
has
a
house
full
of
trip
hazards.
D
D
So
you
know
the
community
paramedics
did
some
amazing
work
with
that,
and
you
know
john's
gonna
tell
you
that
we
had
to
suspend
the
program
because
of
covid
because
of
staffing.
D
You
know
I
and
I
I
don't
want
to
jump
into
either
one
of
these
guys
what
they're
going
to
talk
about,
but
you
know
chief
niemeyer
and
I
have
been
talking
about
even
some
of
the
programs
of
looking
at
how
do
we
take
calls
that
currently,
a
fire
truck
or
an
ambulance
or
both
respond
to
and
now
maybe
we
send
a
community
paramedic
or
maybe
even
a
community
emt
that
could
go
out
and
talk
to
this
person
get
them
the
resources
they
need.
Instead
of
sending
this
like
really
expensive
response,
just.
G
Mr
sheriff,
mr
kenyon,
I
have
to
admit
I'm
unsure.
I
believe
they
are
in
a
just
an
unmarked
patrol
car
yeah
and
as
far
as
transport,
I
I
don't
know
that
answer
can.
B
It
is
a
medical
condition,
but
it's
a
psychiatric
medical
condition,
so
they
don't
need
the
traditional
and
when
somebody
is
having
a
you
know,
psychotic
episode
of
break
whatever
the
last
thing
they
need
to
do
is
be
shoved
in
a
police
car
right
right,
they're,
not
it's
not
a
criminal
offense
to
be
mentally
ill
right,
and
so
we
need
to
figure
out
a
way
to
to
more
safely
and
in
a
calming
way,
help
these
people
disposition
to
wherever
it
is,
they
need
to
go,
and
so
I'm
in
favor
of
anything,
that's
not
a
police
car.
B
D
We
have
we
use.
We
have
a
yukon
that
we
use
it's
a
marked
vehicle
because
they
do
respond
with
lights
and
sirens
to
emergencies,
if
they're
closest
to
it,
while
they're
on
duty
but
yeah.
It's
just
a
yukon
that
they're
using
it's,
not
an
ambulance
that
they're
using
it.
D
And
that's
not
guns,
paramedics
actually
dress
like
I
do,
instead
of
wearing
you
know,
john's
wearing
our
traditional
uniform.
That
has
a
badge.
This
is
a
much
softer
look,
you
know,
so
it's
just
a
different
approach
to
these
patients
really
trying
to
figure
out.
How
do
we
take
care
of
them
and
not
feel
like
have
them
feel
like
they're
being
punished
or
that
we're
right
that
they're,
a
criminal
right
yeah
and
the
people,
the
people?
D
You
know
our
community
paramedics,
I'm
I'm
amazed
when
I
hear
the
stories
about
when
they
have
gone
out
and
had
interactions
with
patients
about
some
of
the
successes
that
they
have
had
with
that
approach.
You
know,
as
opposed
to
just
hey,
you've
got
to
go
to
the
hospital
we
have
to
take.
You.
B
Have
you
run
any
numbers
on
the
cost
savings
on
this?
So
I
mean
it'd
be
fairly
easy
to
do,
because
you
know
either
you're
admitting
them
to,
let's
say
an
intermountain
hospital
and
what
that
cost
is
you
know
et
cetera
or
the
emergency
room.
If
you
can
come
up
with
the
cost
savings
I
mean
the
antigen
fund
is
going
away
and
I
don't
know
how
much
you
know
is
left
in
there
and
that
we
can
fund
this
in
the
interim.
But
this
is
something
that
I
think
we
could
go
to
jfac
on
the
state
level.
B
D
I
know
mr
chair,
commissioner
kenyon
when
we
first
started
the
psychiatric
emergency
team
program,
and
I
don't
have
the
data
right
in
front
of
me,
but
we
looked
at
what
we
would
consider
an
ed
divert
and
each
one
of
those
emergency
department
visits-
and
this
is
a
few
years
ago
where
it
was
cheaper.
It
was
an
average
of
2500
bucks
every
time
that
we
could
bypass
the
ed.
When
we
have
a
total
divert
when
the
person
can
actually
stay
home,
they
have
a
safety
plan,
they
have
family
there.
D
You
know
we're
saving,
an
ed
cost
and
an
entire
psychiatric
visit,
and
so
we
do
have
the
data
from
when
the
program
is
up
and
running.
You
know
and
again
that's
been
a
few
years
ago,
but
it
there
is.
D
Cost
savings:
one
thing
that
that-
and
I
appreciate
what
you
say
about
jfac,
because
right
now
the
cost
savings
go
to
the
you
know
in
in
this
case
indigent
services
if
they
were
indigent,
but
the
cost
savings
were
going
back
to
insurers
or
maybe
medicaid
or
medicare,
depending
on
how
they
were
insured,
and
we
did
reach
out
to
the
insurers
to
see
were
they
interested
in
trying
to
help
fund
this
program,
and
I
think
there
was
interest.
But
there
was
no
movement.
D
You
know
there
was
a
lot
of
talk,
but
nobody
wanted
to
get
the
checkbook
down
yeah
and
sailors
fund.
This
program
we
have
found
in
some
instances,
certainly
with
the
hospitals
that
they,
the
first
program
that
we
evaluated
was
a
post
car,
congestive,
heart
failure,
discharge
program
and
the
data
out
of
that
and
I
actually
met.
D
I
went
down
and
met
with
dr
pate
and
a
publisher,
for
I
can't
remember
which
journal
it
was,
but
the
data
suggested
and
actually
showed
that
we
could
provide
that
evaluation
for
a
post-discharge,
chf
patient
as
well
as
a
nurse
could
but
st
luke's,
even
knowing
that
chose
to
just
hire
care
transitions.
Nurses
instead
of
using
us.
They
did
use
us
for
kind
of
more
indigent
people,
homeless,
people,
but
their
patients
that
were
payers
they
they
took
care
of
themselves
and
and
had
us
work
with
the
people
that
couldn't
pay.
D
The
idea
from
st
luke's
was
that
we
were
partially
funded
by
taxes,
and,
and
so
it
was
more
our
responsibility
to
do
that.
But
the
reason
you
go
back
to
the
reason
that
we
get
tax
money
is
to
put
a
911
response
in
the
street
and
and
not
necessarily
for
this
program,
and
so.
D
B
Right
and
I
think
he
sees
things
very
differently
than
dr
pate
and
then
also
the
cfo
is
about
to
retire.
So
it
might
be
a
really
good
time
to
answer
them
and
talk
to
them.
D
It's
a
very
similar
story.
There
are
some
areas
of
the
country
that
have
found
a
niche
where
they
they
kind
of
stick
with
one
thing.
But
a
lot
of
these
there's
a
there
was
one
big
grant
that
was
granted
to
ramza
and
reno
to
start
a
community
paramedic
program
nurse
triage.
D
They
had
several
things
they
were
doing,
but
when
the
grant
funding
dried
up
a
lot
of
their
community
paramedic
functions,
kind
of
went
with
it
because
they
didn't
have
a
funding
source
to
really
support
this
kind
of
thing
we
aren't
able
to
to
like
a
doctor's
office
or
a
hospital.
We
have
to
build
a
different
part
of
medicare
that
really
falls
more
under
like
a
transport
service,
as
opposed
to
traditional
things.
D
Some
of
that
looks
like
it
might
open
up
a
little
bit
with
the
et3
model,
but
the
eg3
model
is
really
stalled
out
because
of
covid
and
they
kind
of
just
said
you
know,
go
out
and
do
it
it's
the
right
thing
to
do,
but
now
we
need
the
funding
behind
it
to
make
it
really
pay
for
itself.
This
is
one
of
the
real
difficulties
of
community
paramedics.
D
F
F
Years
and
sometimes
people
look
at
it
differently,
they
they
don't
want
to
do
it.
So
it's
hard
to
build
a
program
sort
of
like
like
reno.
Did
they
built
a
program
around
grant
money
and
then
didn't
have
anything
to
back
it
up
and,
and
I've
spoken
with
those
folks,
it's
very
difficult
for
them
to
manage.
B
Well,
I
think
that
the
hospitals
would
be
good
partners
in
this,
and
I
think
the
timing
is
right.
You
know
especially
what
they've
seen
with
covet
and
and
frankly,
they're
not
equipped
to
deal
with
the
psychiatric
long
term
anyway,
and
once
you
get
folks
in
there
and
it's
kind
of
short
term,
then
you
have
to
just
position
disposition
them
to
another
more
longer-term
facility.
B
It's
not
good
for
the
patient
and
I
think
they
know
that
and
if
you
know
we
could
do
something
on
the
front
end,
I
mean
we're
seeing
in
in
our
antigen
hearings.
You
know
we're
seeing
that
seven
to
ten
days
is,
you
know
five
hundred
thousand
dollars,
you
know
it's
not
twenty
thousand
and
so
the
savings.
If
you
were
to
go
through
and
take
a
look
at
these
numbers
today,
I
think
you'd
be
shocked,
so
they
could.
That
would
free
them
up
to
then
take
on.
B
I
hate
to
say
it,
but
they,
like
you,
know
they
like
cases
where
they
make
they
make
money
with
people
that
can
afford
to
pay
right.
Elective
surgeries,
basically.
H
Well,
additionally,
the
the
indigenous
program
is
going
away
completely,
so
they
won't
be
able
to
bill
us
for
an
expensive
standpoint
even
for
an
emergency
room
they're
not
going
to
be
able
to
bill
us,
because
it's
just
it's
done.
A
D
We'll
see
you
know
with
the
legislative
change,
maybe
there
will
be
a
little
more
sense
of
urgency
to
actually
do
something
because
they've
always
been
super
supportive.
H
D
I
don't
think
that
mark
or
john
would
disagree
that
they
are
behind
us,
but
not
financially.
That's
the
piece.
H
A
B
D
Yeah
we
can
certainly
we
can
start
there.
You
know
I
think
steve
was
looking
at
just
for
your
budget
coming
up.
D
There
was
that
question
about
the
certainly
the
55
000
that
indigent
has
given
us
to
support
the
psychiatric
emergency
team
program
in
the
past,
and
so
I
think
he
was
just
interested
to
see
if
the
board
was
willing
to
do
kind
of
a
contract
like
we
had
with
with
indigent
to
help
fund
at
least
a
portion
of
that
program,
if
not
more
so,.
A
You
indicated
earlier
that
you
build
medicare,
there's
different,
isn't
it
medicaid
that
you
were
talking
about
or
is
it
medicare
well.
D
We
bill
medicare
medicaid,
all
the
insurances
yeah,
it's
the
medicare
portion
that
I
that
I
was
speaking
to
is
instead
of-
and
I
don't
want
to
get
too
convoluted
here.
But
if
you
go
to
a
hospital
or
a
doctor's
office,
they
build
what
are
called
cpt
codes,
which
is
a
payment
for
a
service.
D
H
D
They
can
build
cpg
codes
yeah,
which
is
exactly
what
they've
done
magic
valley.
Paramedics
in
twin
falls
is
a
kind
of
a
shared
service,
so
the
magic
valley
in
in
twin
falls
county
jerome
county.
They
collect
the
taxes,
they
hand
the
taxes
over.
I
don't
want
to
say
they
hand
them
over,
but
they
work
with
the
hospital.
The
hospital
actually
provides
the
ambulance
service.
So
you
know
magic
valley
was
actually
going
out
and
doing
post-covered.
D
D
D
There
are
a
lot
of
issues
with
we
had
to
to
be
licensed.
As
a
hipaa
contractor,
we
had
very
limited
access
initially
to
their
chart.
Writing
software,
where
an
employee
could
just
hop
right
in
there
and
do
what
they
needed
to
do.
D
There
were
a
lot
of
issues
that
we
ran
into
with
being
a
contractor
for
them
that
you
know,
I
think
they
felt
like
they
could
just
do
it
on
their
own
a
little
easier
and
have
the
control.
I
think,
looking
at
it
several
years
later,
I
I
really
think
it
came
down
to
control
of
their
own.
D
G
No,
mr
chair
commissioners,
good
morning,
I
think,
commissioner
kenyon
to
your
point
about
a
strategic
plan
on
the
sheet.
Maybe
if
we
can
just
quickly
look
at
goals
and
focus
for
the
relaunch
and
revamp
of
the
program,
I
think
that,
as
chief
rain
mentioned,
that
we
would
probably
stick
with
the
combination
of
the
initiatives
that
seem
to
make
the
most
impact,
which
would
be
the
field,
referrals,
the
psychiatric
emergency
team
and
then
maybe
some
innovative
and
alternative
responses
in
the
911
system
and
kind
of
meld.
G
Those
kind
of,
irrespective
of
the
exact
program
focus.
We
understand
that
we
need
to
show
impact,
and
so
we
would
like
to
stick
with
probably
three
areas
of
impact
and
that
would
be
utilization,
a
patient
and
provider
experience
and
then
an
expenditure
savings
and
then,
under
each
of
those
areas,
we'll
select
different
methods
that
will
track.
That
will
show
the
impact
in
those
three
areas
and
again,
commissioner,
kenyon
to
your
point
about
cost
savings.
G
We
we
actually
are
thinking
potentially
to
look
at
expenditure
versus
cost
and
we
think
if
it
maybe
doesn't
sound
as
nice
as
costs.
You
know
we
saved
millions
of
dollars
in
cost,
but
that's
not
what's
what
was
actually
paid
out
and
especially
for
the
board
and
the
taxpayers.
G
We
think
if
we
look
more
at
expenditure
savings,
so
that
is
a
true
amount
that
that
can
show
the
impact
of
what
we're
doing
on
a
financial
kind
of
level
and
then
again
that
that
commitment
to
the
patient
and
the
provider
is
something
that
we
really
are
going
to
focus
on.
B
Can
you
put
together,
like
a
two-page
business
executive,
summary
statement
of
the
problem
all
the
way
down
through
the
the
numbers
that
you're
talking
about
who
your
market
target
market
is
based?
On
his
you
know,
historical
data
and
then
forecasting
and
then
who
potentially
partners
could
be
in
in
the
revenue
side
of
things.
So
we
know
what
the
ask
is
for
ada,
county
taxpayers
or
what
the
ask
is
temporarily
out
of
what's
left
in
the
indigenous
fund,
but
then
long-term
hospital
insurance
providers.
What
not?
B
Let's
you
know,
get
it
no
more
than
two
pages
something
that
then
we
can
look
at,
and
so
we
can
be
fairly
articulate
when
we
have
meetings
with
hospitals
and
folks
that
we
need
to.
But
I'd
like
to
see
yeah
just
at
least
business
model
summary
pretty
cool.
E
Yes,
so
the
focus
will
be
psychiatric
and
what
are
the
other
fields.
D
Yeah,
mr
commissioner,
davidson
field
referral,
so
that's
the
program
where
any
paramedic,
any
law
enforcement,
official
or
any
firefighter
can
say.
We've
identified
a
problem
with
this
patient
that
isn't
necessarily
something
that
is
medical
in
nature.
It
could
be
medical
in
nature,
but
a
reason
for
our
community
paramedic
to
go
out
and
visit
that
person
see.
Are
there
resources
that
they
could
get?
That
would
keep
them
out
of
the
hospital
improve
their
life,
and
you
know
decrease
the
chance
that
they're
going
to
need
to
call
9-1-1
those
types
of
things.
B
You
might
want
to
look
at
especially
thinking
through
this
if
we're
going
to
have
want
st
luke's
and
saint
nelson
partners
with
us
what
the
telemedicine
component
could
be
right,
the
psychiatric
piece
and
so
they're
not
losing
business
they're
still
able
to
bill
but
able
to
bill
having
that
patient
stay
in
their
home,
which
is
again
usually
better
right
to
stabilize
these
folks
and
so
yeah.
Add
that
piece
to
it,
because
then
you
guys
have
the
capability
to
oh
yeah,
yeah,
yeah,.
D
B
Cool
awesome
and
then
I'll,
you
know
just
be
thinking
about
bigger
picture
as
we
try
to
integrate
better
with
fire,
so
we're
not
spending
80
million
on
fire
every
year
and
not
getting
our
full
thing
for
our
dollar.
You
can
somehow
integrate
those
two
and
get
your
you
guys.
Your
wages
up
where
they
need
to
be
consistently.
Also
is
another
big
huge
item
in
my
mind,
getting
paid
the
same
amount
as
mcdonald's
people,
yeah,
okay,.
H
A
Well,
thank
you.
Thank
you
appreciate
you
coming
in
giving
us
our
one-on-one
looking
forward
to
your
updated
report
and
with
that
we
are
in
recess
all
right.
Thank
you.
A
Good
morning
today
is
tuesday,
the
april
19th.
The
time
is
10
o'clock,
the
board
of
commissioners
sitting
at
the
board
of
avalor
community
infrastructure
district
number
one
is
in
session
to
conduct
its
weekly
open
business
meeting.
All
three
commissioners
are
present,
madam
clerk,
do
we
have
any
changes
to
the
agenda?
No.
A
You've
heard
the
motion
favor.