Subject:
Title
Medicaid Public Emergency Medical Transportation Letter of Agreement between Pinellas County Emergency Medical Services dba Sunstar and the Agency for Health Care Administration that allows Pinellas County to participate in the State Fiscal Year 2019-2020 Medicaid Public Emergency Medical Transportation Intergovernmental Transfer program.
label
Recommended Action:
Recommended Action
Approval of the Medicaid Public Emergency Medical Transportation (PEMT) Letter of Agreement with the Agency for Health Care Administration to participate in the extension of the PEMT program via an Intergovernmental Transfer (IGT) program.
• The PEMT IGT is an annual program that supplements unreimbursed fees associated with emergency ambulance transportation services.
• It is provided by public entities to Medicaid recipients enrolled in Managed Medical Assistance plans.
• Projected net revenue of $2,537,404.62 to the Emergency Medical Services Fund in Fiscal Year 2020.
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 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 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 which involves 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 Managed Care Organizations (MCOs), AHCA must be in possession of the physical dollars the service providers are projected to dedicate to this Medicaid population in order to draw down Federal program funds.
Pinellas County EMS is projected to submit an IGT in the amount of $1,590,470.15 and to receive an allotment in the amount of $4,127,874.77.
The 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 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 Information:
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 average 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 was 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 the end of October 2019, and that due dates may be adjusted. Despite this fact, AHCA is requiring all executed LOA’s by October 1, 2019. 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 $4,127,874.77 in revenue, which would be offset by a projected expenditure of $1,590,470.15, resulting in projected net revenue of $2,537,404.62. The numbers represented here reflect the current program projections from AHCA that are subject to change. In order to accommodate potential upward changes, and maximize revenue, the IGT amount in the Letter of Agreement has been modified to reflect an IGT amount of $2.1M. Once this document is executed, the IGT amount cannot be exceeded. An upward revision of the program distribution would necessitate a higher IGT amount. These amounts are not included in the FY20 Proposed Budget as information regarding this program was not available during the FY20 Budget Development Process.
Staff Member Responsible:
Jim Fogarty, Director, Safety & Emergency Services
Partners:
Florida Agency for Health Care Administration
Various Managed Medical Organizations
Attachments:
Public Emergency Medical Transportation Letter of Agreement