Agreed-Upon Procedures – Fiscal Years Ended June 30, 2022, 2023, 2024

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Report Summary

Background

The Auditor of Accounts (AOA) contracted with Gunnip & Company LLL to perform an Agreed-Upon Procedures engagement on the Paramedic Reimbursements of New Castle County, Kent County, and Sussex County (County/Counties) for the years ended June 30, 2022, 2023, 2024. Management of each county and Department of Health and Social Services, Division of Public Health, Office of Emergency Medical Services, are responsible for compliance with 16 Del. C. §9814.  The State provides 30% of operational costs for minimum paramedic staff hours, with counties providing the remaining 70%. 

The paramedic program includes a coordinated advanced life support system, under qualified  medical supervision, which has the responsibility for providing a rapid response capability in the delivery of emergency medical services to individuals who become unexpectedly ill or incapacitated or who are otherwise placed in a position where highly skilled medical assistance must be rendered to sustain or maintain such individual prior to institutional health care.  The paramedic services program is utilized for medical emergencies, either at the scene or while the patient is in transit to a health facility.

The State Auditor is authorized under 29 Del. C., §2906 to conduct audits.

Key Information and Findings

The State, as approved in the Grant-in-Aid Acts, is reimbursing the Counties based solely on their budgeted expenditures for Emergency Medical Services.  The AUP identified regulations 16 Del. C. §9814 (g, h, i) which are superceded because of the language communicated to the Counties via the Grant-in-Aid Acts.

In the performance of the agreed upon procedures, AOA observed one out of the six agreed-upon procedures were not fully in conformance with 16 Del. C. §9814:

• Gunnip & Company LLP noted the following differences between budgeted versus the actual expenditures as identified in the below tables.

FY23 Reimbursement Based on FY22 Budget

County	County Budget Submission	County Budget Actual	Budget – Actual Difference
New Castle	22,422,185.88	20,678,008.25	1,744,177.63
Kent	7,714,760.00	7,588,836.72	125,923.28
Sussex	17,357,091.00	17,160,780.58	196,310.42
Total	53,428,181.82	51,453,928.62	1,974,253.20

FY24 Reimbursement Based on FY23 Budget

County	County Budget Submission	County Budget Actual	Budget – Actual Difference
New Castle	24,102,008.82	24,309,782.32	-207,773.50
Kent	8,138,620.00	7,990,913.37	147,706.63
Sussex	21,187,553.00	19,153,232.93	2,034,320.07
Total	53,428,181.82	51,453,928.62	1,974,253.20

FY25 Reimbursement Based on FY24 Budget

County	County Budget Submission	County Budget Actual	Budget – Actual Difference
New Castle	26,918,333.00	25,788,573.26	1,129,759.74
Kent	8,978,560.00	8,499,192.12	479,367.88
Sussex	21,058,621.00	20,571,215.37	487,405.63
Total	56,955,514.00	54,858,980.75	2,096,533.25