Subject:
Title
Updated 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 allowing Pinellas County to participate in the State Fiscal Year 2019-2020 Medicaid Public Emergency Medical Transportation Intergovernmental Transfer program.
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Recommended Action:
Recommended Action
Approval of the Updated Medicaid Public Emergency Transportation (PEMT) Letter of Agreement (LOA) with the Agency for Health Care Administration (AHCA) and Intergovernmental Transfer program (IGT) Questionnaire to participate in the expansion of the PEMT program via an IGT program.
• The PEMT IGT is the annual program supplementing unreimbursed fees associated with emergency ambulance transportation services provided by public entities to some Medicaid recipients.
• Pinellas County signed a Letter of Agreement (LOA) with AHCA in September 2019, (Granicus #19-1607A).
• Subsequent to the September agreement, AHCA made minor changes to the LOA originally approved adding a requirement to complete and sign “Intergovernmental Transfers Questionnaire”.
• This item is the updated agreement and questionnaire.
• Projected net revenue of $2,838,530.71 to the Emergency Medical Services Fund in Fiscal Year 2020.
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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:
Participation in this program will result in a projected net gain to the EMS fund in the amount of $2,838,530.71.
AHCA required the Letter of Agreement (LOA) to be returned, signed by the County by October 1, 2019. Pinellas County complied through Granicus #19-1607A. Subsequent to that time, AHCA made minor changes to the LOA and provided a more accurate estimate of the amount of funding to be provided as part of the IGT. Although AHCA required the modified LOA to be returned by December 31, 2019, Pinellas County was granted an extension to January 31, 2019. In addition, AHCA now requires a questionnaire form to be completed and submitted with the LOA that was not initially required.
The PEMT IGT is an expansion of the original program implemented in 2015 which supplements unreimbursed cost 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 applies to the Medicaid population required to enroll in an MMA plan. The PEMT-IGT differs from the initial PEMT program in several complex details.
Public entities are required to execute an annual LOA and IGT in the amount invoiced by AHCA. Program funds are projected to be disbursed on a quarterly basis. Situations whereby utilization within a specific region drop below 95% during the program period, would necessitate a return of a portion of the funds to AHCA.
The LOA is broad in scope and is utilized by AHCA for programs involving hospitals and ambulances. For that reason, some of the verbiage contained in the LOA does not specifically pertain to counties, cities, municipalities, special purpose districts, etc. The language is created by AHCA and cannot be modified by agencies choosing to participate.
42 CFR Part 433 subpart B indicates public funds may be considered as the State’s share in claiming Federal Financial Participation. The County’s IGT is applied toward the States portion required to draw down federal funds.
Background Information:
The 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 $1,600.00 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 were not eligible for the 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.
AHCA acknowledges, the PEMT program will not be formally approved until sometime in 2020 and that due dates may be adjusted. Despite this fact, AHCA is requiring Pinellas County to return the signed LOA along with the questionnaire by January 31, 2020. To participate in PEMT IGT, public entities are also required to execute agreements with MMA Plans. AHCA is currently coordinating with MMA plans to develop a standard agreement.
Fiscal Impact:
Projected receipt of $4,617,749.65 in revenue, which would be offset by a projected IGT expenditure of $1,779,218.94, resulting in projected net revenue of $2,838,530.71. These numbers reflect the current program projections from AHCA that are subject to change. These amounts are not included in the FY20 Adopted Budget as information regarding this program was not available during the FY20 Budget Development Process nor has the program been formally approved by AHCA.
Staff Member Responsible:
Jim Fogarty, Director, Safety & Emergency Services
Partners:
Florida Agency for Health Care Administration
Various Managed Medical Organizations
Attachments:
LOA approved as to form by legal
Intergovernmental Transfer Questionnaire from AHCA
QA from AHCA frequently asked questions
Intergovernmental Transfer Schedule 2019/2020 from AHCA