Subject:
Title
Letter of Agreement and Subcontractor Business Associate Agreement with LogistiCare Solutions, LLC, a non-emergency medical transportation broker, to provide reimbursement to Pinellas County Board of County Commissioners, dba Sunstar, for non-emergency ambulance transportation of Medicaid recipients.
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Recommended Action:
Recommended Action
Approval by the Board of County Commissioners, and execution by the Chairman of the Letter of Agreement (LOA) and Subcontractor Business Associate Agreement (BAA) with LogistiCare Solutions, LLC (LGTC), a non-emergency medical transportation (NEMT) broker, to provide reimbursement for non-emergency ambulance transportation of Medicaid recipients.
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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:
The agreements will provide Emergency Medical Services (EMS) with the mechanism required by the Agency for Health Care Administration (AHCA) to be paid for eligible non-emergency ambulance transportation services. The annual income from LGTC is estimated to be $300,000.
Background Information:
When Florida Medicaid transitioned to a Statewide Medicaid Managed Care (SMMC) program (June 2014 for Pinellas County) to administer Managed Medical Assistance (MMA) plans on behalf of the Agency for Healthcare Administration (AHCA), ambulance providers were required to enter into contracts with the transportation brokers utilized by MMA plans in order to be reimbursed for non-emergency transportation. Including LGTC, there are four (4) transportation brokers representing the twelve (12) Florida MMA plans; the MMA plans and transportation brokers are selected and contracted by AHCA.
Specifically, Sections 7.2 Authorization/Specific Criteria and 8.2 Reimbursement/Specific Criteria of the Florida Medicaid Non-Emergency Transportation Services Coverage Policy (October 2016) mandate that all non-emergency transports for Medicaid recipients must be coordinated, authorized and submitted for payment to the transportation broker contracted with AHCA. Execution of this LOA and BAA provides the mechanism necessary for EMS to be reimbursed for non-emergency ambulance transportation services provided to Medicaid recipients enrolled with Amerigroup Florida, Better Health, Clear Health Alliance, Humana Medical Plan, Molina Healthcare of Florida, Simply Healthcare, Sunshine Health, and United Healthcare of Florida MMA Plans; these eight (8) MMA plans utilize LGTC as their transportation broker. The 4 other MMA plans (there are a total of 12 MMA plans) use one or more of the other transportation brokers for non-emergency transport processing
The total annual charges billed by the County for non-emergency transports for Medicaid recipients is approximately $900,000; of this amount, the LOA with LGTC, will provide an estimated annual reimbursement amount of $300,000.
EMS has recently contracted with one (1) other transportation broker, Medical Transportation Management, Inc., and is conducting discussions and contract negotiations to execute contracts with the remaining two (2) MMA transportation brokers; as EMS continues to execute contracts with the remaining MMA brokers, additional annual reimbursement is expected.
Currently trending is the utilization of transportation brokers by private insurance companies for non-emergency ambulance transportation reimbursement; future contracts with additional transportation brokers may be necessary to preserve current levels of reimbursement from private insurance companies.
Fiscal Impact:
Projected revenue is $300,000 per year for the Emergency Medical Services Fund and is included in the proposed Fiscal Year 2019 Budget.
Staff Member Responsible:
James G. Fogarty, Bureau 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:
Letter of Agreement with LogistiCare Solutions, LLC
Subcontractor Business Associate Agreement with LogistiCare Solutions, LLC
List of MMA Plans and Transportation Brokers for Medicaid Non-Emergency Transports