Subject:
Title
First Amendment to the Letter of Agreement between the Board of County Commissioners dba Sunstar and LogistiCare Solutions, LLC.
label
Recommended Action:
Recommended Action
Approval of the First Amendment to the Letter of Agreement between the Board of County Commissioners dba Sunstar and LogistiCare Solutions, LLC increasing the rate for non-emergency transportation services.
• The existing contract provided the mechanism for re-imbursement for Medicaid Managed Medical Assistance (MMA) patients at the then current allowable rate.
• The contract is specific to recipients enrolled in a Managed Medical Assistance Plan for which LogistiCare Solutions, LLC serves as the transportation broker.
• This amendment increases the rate of reimbursement to the current Medicare allowable rate for non-emergency ambulance transportation services.
• The rate change is projected to increase revenues by $214,000.
• Budgeted revenue for Medicaid MMA plan is $514,000 compared to prior revenue of $300,000.
Body
Strategic Plan:
Deliver First Class Services to the Public and Our Customers
5.1 Maximize partner relationships and public outreach
5.2 Be responsible stewards of the public’s resources
5.3 Ensure effective and efficient delivery of county services and support
Summary:
LogistiCare Solutions, LLC contracts with MMA Plans to prior authorize and reimburse ambulance service providers for non-emergency transportation services to recipients enrolled in their MMA plans. The Agency for Health Care Administration (AHCA) requires ambulance service providers to enter into agreements with MMA Plans, or their contracted broker, to be reimbursed for nonemergency ambulance transportation. Initially, there were contracting challenges unique to a governmental entity complying with this requirement which were ultimately resolved. At the time the Agreement was executed, the reimbursement rate reflected the current Medicaid allowable that was
in effect prior to the implementation of the Statewide Medicaid Managed Care (SMMC) program of which MMA is a part. Ongoing Pinellas County Ambulance Billing & Financial Services Division’s staff coordination with LogistiCare Solutions, LLC led to this first amendment to modify the reimbursement to the maximum Medicare allowable. When Logisticare Solutions, LLC assigns (approves) a trip to an ambulance provider, the reimbursement rate for that service is based on an agreed upon amount established via contract with the service provider. The annual revenue from LogistiCare Solutions,
LLC under this amendment is estimated to be $514,000.
Background Information:
In 2014 Florida Medicaid Agency for Health Care Administration (AHCA), transitioned to a SMMC system which consist of three components: the Long-Term Care (LTC) Program; the Managed Medical Assistance (MMA) Program; and the Dental Program. AHCA contracts with various plans to provide SMMC services. Ambulance transportation services are eligible under the MMA component. AHCA requires ambulance service providers to enter into contracts with MMA Plans, or their contracted transportation brokers, in order to be reimbursed for non-emergency transportation
services; the reimbursement of emergency services are not subject to contracting.
This amendment to the fee schedule will result in reimbursement of approximately $514,000 for these services vs $300,000 under the current schedule set at the original contracted amount.
In addition to Medicaid, the utilization of transportation brokers is currently trending with private insurance companies for non-emergency ambulance transportation reimbursement; LogistiCare is a prominent player in this industry.
Fiscal Impact:
Projected revenue is $514,000 per year for Emergency Medical Services Fund and is included in the Fiscal Year 2020 Adopted Budget. Estimated annual cost to the County for non-emergency transports for Medicaid recipients is $900,000.
Staff Member Responsible:
James G. Fogarty, Director, Safety and Emergency Services
Partners:
Medicaid Recipients
LogistiCare Solutions, LLC
Amerigroup Florida, Inc.
Better Health
Clear Health Alliance
Humana Medical Plan
Molina Healthcare of Florida
Simply Healthcare
Sunshine Health
United Healthcare of Florida
Centers for Medicare & Medicaid Services (CMS)
Agency for Health Care Administration (AHCA)
Attachments:
SUNSTAR-LOGISTICARE ACCOUNT SETUP AGREEMENT RATE AMENDMENT
Executed Letter of Agreement Logisticare Solutions, LLC
Executed Account Setup Agreement RATE TABLE