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 2022-2023 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) via DocuSign platform 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 AHCA prior to October 1, 2022.
• 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.
• AHCA is implementing a new procedure for the dissemination and receipt of Letters of Agreement (LOA) that will improve efficiency and accuracy of the State’s record keeping. As of July 1, 2022, all LOAs will be sent and received by the Agency via DocuSign. DocuSign is a secure and HIPAA compliant service that tracks signatures and countersignatures in an auditable format.
• This LOA is above the County Administrator’s delegated authority but is being approved to meet the statutory deadline noted in Florida Statute 409.908, section 26 of October 1, 2022, to secure projected net revenue of $6,768,362.54 to the Emergency Medical Services Fund in Fiscal Year 2023. The LOA was not received by the Department in time to make the September 22, 2022 agenda.
• A separate Legistar file will go to the Board at a future meeting to ratify this item.
Body
Strategic Plan:
Deliver First Class Services to the Public and Our Customers
5.2 Be responsible stewards of the public’s resources
5.3 Ensure effective and efficient delivery of county services and support
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 various cost reports. 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 the service providers are projected to dedicate to this Medicaid population to draw down Federal program funds. Pinellas County EMS is projected to submit an IGT in the amount of $4,502,849.02 and to receive an allotment of $11,271,211.56 resulting in net revenue of $6,768,362.54.
Background/Explanation:
Reimbursement for ambulance transportation services for Medicaid recipients has remained stagnant for decades, currently at: Basic Life Support $136.00; Advanced Life Support $190.00; and Advanced Life Support, Level 2 (ALS2) $250.00. The State-wide cost to cities, counties, special purpose districts, etc., for providing EMS transportation services averages $1,800.00 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 initially limited to recipients not enrolled in an MMA plan.
Fiscal Impact:
Projected net revenue of $6,768,362.54.
Total distributions received from MMA plans are projected at $11,271,211.56, which would be offset by a projected intergovernmental transfer/expenditure of $4,502,849.02. These numbers reflect current program projections from AHCA that are subject to change.
The FY23 Proposed Budget includes $3,400,800 for the Intergovernmental Transfer and associated revenue of $8,139,520.00 (95%) that was based on historical actuals for this program. The actual IGT from previous years were as follows: FY22 - $2,864,103 (revenue 8,431,624) FY21 $1,779,747 (revenue $5,007,535) and FY20 $1,734,888 (revenue 4,614,750) for the Emergency Medical Services (EMS) Fund.
A budget amendment for this additional appropriation related to the IGT may be necessary in FY23.
Delegated Authority:
The County Administrator will execute the agreement and submit to the Board of County Commissioners (BCC) to ratify at a future BCC meeting.
Staff Member Responsible:
Jim Fogarty, Bureau Deputy Director, Safety & Emergency Services Department
Partners:
Florida Agency for Health Care Administration (AHCA)
Various Managed Medical Organizations
Attachments:
Public Emergency Medical Transportation Letter of Agreement (LOA)
SFY 2022-2023 PEMT MCO Projections from AHCA