Subject:
Title
Medicaid Public Emergency Medical Transportation Letter of Agreement between Pinellas County Emergency Medical Services d/b/a Sunstar and the Agency for Health Care Administration that allows Pinellas County to participate in the State Fiscal Year 2026-27 Medicaid Public Emergency Medical Transportation Intergovernmental Transfer program.
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Recommended Action:
Recommended Action
Approval and execution by the County Administrator of the Medicaid Public Emergency Medical Transportation (PEMT) Letter of Agreement (LOA) with the Agency for Health Care Administration (AHCA) to participate in the PEMT Medicaid Managed Assistance (MMA) plan via an Intergovernmental Transfer (IGT) program. The LOA must be submitted to the Agency for Health Care Administration (AHCA) prior to October 1, 2026.
• The PEMT IGT is an annual program that supplements unreimbursed costs associated with emergency ambulance transportation services.
• Eligibility of the program is associated with emergency ambulance transportation provided by public entities to Medicaid recipients enrolled in MMA plans.
• Projected net revenue is not known at this time as AHCA is experiencing delays that impact the ability to finalize the payment model. As a temporary measure, the attached Letter of Agreement (LOA) provided by AHCA includes a placeholder of $1 for the intergovernmental transfer.
• This program has generated average net revenue of $9.8 Million over the last 5 Fiscal Years for the Emergency Medical Services (EMS) fund.
• Funding is currently included in the FY27 budget. Total budgeted distributions received from MMA plans are projected at $17.2M, which offset a projected expenditure of $8.4M, resulting in net revenue of $8.8M. Funding for future years is dependent on approval in the annual County Operating Budget.
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Strategic Priorities:
Smart Service Delivery
4.2 Achieve and maintain a high level of customer satisfaction.
4.4 Pursue continuous improvement.
Summary:
The PEMT IGT is an extension of the original program implemented in 2015 which supplements unreimbursed costs associated with ambulance transportation services provided to Medicaid recipients that were not required by State Statute 409.965 to enroll in an MMA plan. The PEMT IGTs apply to the Medicaid population required to enroll in an MMA plan. 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 fee-for-service expenses associated with ambulance services provided to Medicaid recipients that involve the preparation of a cost report. State distributions associated with PEMT IGT are derived from a calculation based on the number of Medicaid recipients enrolled in MMA Plans in the region serviced by the providers. Given that the distribution is based on data provided by the Medicaid Managed Assistance (MMA) Plans, AHCA must be in possession of the physical dollars that service providers are projected to dedicate to this Medicaid population to draw down Federal program funds. The IGT payment due from Pinellas County EMS is currently unknown until AHCA finalizes the FY26-27 payment model. SES has received average net revenue of $9.8 Million over the last 5 years from this program.
The public entities are required to execute an annual LOA and IGT in the amount invoiced by AHCA. Situations whereby utilization within a specific region drop below 95% during the period would necessitate a return of a portion of the funds to AHCA.
The LOA was drafted by AHCA’s legal department, and language cannot be modified in any manner. The LOA is broad in scope, as it is utilized by AHCA for similar programs involving hospitals. For that reason, some of the verbiage contained in the LOA does not specifically pertain to counties, cities, municipalities, special purpose districts, etc.
Background/Explanation:
Participation in the Public Emergency Medical Transportation (PEMT) Intergovernmental Transfer (IGT) Program is authorized pursuant to Section 409.908, Florida Statutes, and the annual Florida General Appropriations Act.
The deadline requiring the execution and submission of the Letter of Agreement (LOA) to the Agency for Health Care Administration (AHCA) prior to October 1st is a mandatory administrative and contractual deadline established by AHCA to align with the annual Statewide Medicaid Managed Care (SMMC) contract cycle and federal Medicaid funding timelines.
Reimbursement for ambulance transportation services for Medicaid recipients has remained stagnant for decades, currently at: Basic Life Support $137.96; Advanced Life Support $192.73; and Advanced Life Support, Level 2 (ALS2) $280.74. The State-wide cost to cities, counties, special purpose districts, etc., for providing EMS transportation services averages $2,500.00 per transport.
The Florida Fire Chiefs’ Association (FFCA) lobbied the legislature to obtain the Federal Share reimbursement for local government ambulance transport costs. Due to the success of their efforts, AHCA implemented PEMT for ground transportation in 2015; which was limited to recipients not enrolled in an MMA plan.
Ninety percent of all Florida Medicaid recipients are enrolled in an MMA Plan that was not eligible for the original PEMT Program. The FFCA was successful in getting the Legislature to approve an expansion of the PEMT Program to include reimbursement for MMA recipients during the 2019 Legislative session, via an IGT program.
Fiscal Impact:
Projected net revenue is currently unknown until AHCA finalizes their payment model.
This program has generated average net revenue of $9.8 Million over the last 5 Fiscal Years to the Emergency Medical Services Fund.
The FY26-27 budget includes net revenue of $8.8 Million within the Emergency Medical Services Fund. A net reduction is expected due to the Federal Government reducing its funding to State Medicaid Programs.
Delegated Authority:
Authority for County Administrator to sign this agreement is granted under Resolution No. 23-18.
Staff Member Responsible:
David Hare, Bureau Director, Safety and Emergency Services Department
Partners:
Florida Agency for Health Care Administration (AHCA)
Various Managed Medical Organizations
Attachments:
Public Emergency Transportation Letter of Agreement (LOA)
Resolutions No. 23-18
Email from AHCA regarding delay in finalizing the PEMT Payment Model