Subject:
Title
Letter of Agreement with Medicaid Managed Care Organizations as a required implementation step to receive funding from the Medicaid Public Emergency Medical Transportation Intergovernmental Transfer Program, which was authorized via a Letter of Agreement between Pinellas County and the Agency for Health Care Administration.
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Recommended Action:
Recommended Action
Approval and execution by the County Administrator for the Letters of Agreement (LOA) with Medicaid Managed Care Organizations (MCO) who provide Medicaid Services to eligible recipients enrolled in Sunshine Health, Simply Healthcare, Humana, and Florida Community Care (MCOs serving Medicaid Region C of which includes Pinellas County) as a required implementation step to receive funding from the Medicaid Public Emergency Medical Transportation (PEMT) Intergovernmental Transfer (IGT) Program, which was authorized via a Letter of Agreement between Pinellas County and the Agency for Health Care Administration (AHCA); Granicus Number 24-0480D.
• The LOA must be executed by Pinellas County initially and returned to the MCOs for completion along with a W9. The LOAs serve as a program mechanism to authenticate the current relationship between the ambulance service provider and the MCO.
• A LOA was executed with the AHCA to participate in the PEMT IGT Program that is estimated to generate net revenue of $9.2M and was approved in December 2024 through Granicus Number 24-0840D. Execution of this LOA with the MCO is the final step necessary to receive eligible reimbursement from Medicaid MCOs under this program.
• This project is funded and consistent with the FY25 Adopted Budget. It has been included in the FY26 Proposed Budget as well.
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Strategic Priorities:
Healthy and Safe Communities
2.1 Improve public health
Smart Service Delivery
4.2 Achieve and maintain a high level of customer satisfaction
Summary:
PEMT IGT is an annual program that supplements unreimbursed costs associated with emergency ambulance transportation services provided by public entities to Medicaid recipients enrolled in Medicaid Managed Medical Assistance (MMA) Plans. The proportionate fund allocation of PEMT IGT is derived from projections of supplemental support needed by ambulance service providers and the current year’s Medicaid managed care population, based on historical utilization. Situations whereby utilization falls below 5% of the projection would necessitate a return of a portion of the funds to AHCA; utilization above the projected amount would not increase funding. Pinellas County Emergency Medical Services has been invoiced for the IGT for $6,934,895.85 and is projected to receive an allocation for $16,191,678.38, which results in net revenue of $9,256,782.53. The invoiced amount is required by AHCA as they must have the physical dollars to draw down Federal program funds. Providers must execute LOAs with MCOs in their corresponding region before receiving an allocation from PEMT IGT.
Background/Explanation:
AHCA implemented PEMT for ground transportation in 2015 which was limited to recipients not required to be enrolled in an MMA plan per Florida Statute 409.965. Approximately ninety percent (90%) of all Florida Medicaid recipients do not meet the requirements of this Florida Statute and are required to be enrolled in MMA Plans. On April 8, 2020, AHCA approved the expansion of the PEMT Program to include reimbursements for MMA recipients, via an IGT program.
The PEMT IGT differs from the initial PEMT program in that it is not a Certified Public Expenditure (CPE) Program that allows public entities to certify expenditures associated with ambulance services to Medicaid recipients and involves the preparation of cost reports. PEMT IGT is a forward projection based on service needs and the number of Medicaid MMA plan enrollees in a specific region per year.
The PEMT and PEMT IGT programs are crucial revenue sources as Medicaid’s ambulance transportation reimbursement amounts have seen only a negligible increase after remaining stagnant for decades, currently at: Basic Life Support $152.73; Advanced Life Support $213.37; and Advanced Life Support, Level 2 (ALS2) $280.74. The average cost for providing EMS ambulance transportation service for Pinellas County in FY25 is approximately $857 based on the AHCA allowable Medicaid cost report.
Fiscal Impact:
The funding is consistent and included in the FY25 Budget. Total distributions received from MMA plans are projected at $16,191,678.38, which offset a projected expenditure of $6,934,895.85, resulting in net revenue of $9,256,782.53. The amounts submitted in the budget were higher, and based on historical actuals, the IGT transfer was included in the FY25 budget at $11,112,200, and the Gross Revenues were budgeted at $22,826,000. The amounts are subject to change. The funds allocated to this program were decreased for FY25.
Delegated Authority:
Authority for the County Administrator to sign the Letters of Agreement with Medicaid Managed Care Organizations authorized by BOCC in Resolution 23-18. The LOA between AHCA and Pinellas County authorizing the dollar amount of the program was approved by the County Administrator Granicus 24-0840D.
Staff Member Responsible:
James G. Fogarty, Bureau Director, Safety & Emergency Services Department
Partners:
Agency for Health Care Administration (AHCA)
Sunshine State Health Plan
Simply Healthcare
Humana
Florida Community Care
Attachments:
MCO Letters of Agreement
SFY 2024-2025 PEMT MCO Allotments
Resolution 23-18