Subject:
Title
Letters of Agreements with Medicaid Managed Care Organizations as a required implementation step to receive funding from the Medicaid Public Emergency Medical Transportation Intergovernmental Transfer Program, which was authorized via a Letter of Agreement between Pinellas County and the Agency for Health Care Administration.
label
Recommended Action:
Recommended Action
Approval and execution by the County Administrator of the letters of agreement with Medicaid Managed Care Organizations as a required implementation step to receive funding from the Medicaid Public Emergency Medical Transportation Intergovernmental Transfer Program, which was authorized via a Letter of Agreement between Pinellas County and the Agency for Health Care Administration; Granicus Number - 19-2371A.
• The LOA must be executed by Pinellas County initially and returned to the MCOs for completion along with a W9. The LOAs serve as a program mechanism to authenticate the relationship that currently exists between the ambulance service provider and the Managed Care Organizations (MCO).
• A LOA was executed with the Agency for Health Care Administration (AHCA) to participate in the PEMT IGA Program that is estimated to generate net revenue of $2.8M and was approved in January 2020 through Granicus Number 19-2371A. Execution of these LOA’s with the MMO’s in this Granicus item is the final step necessary to participate in this program.
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:
PEMT IGT is an annual program that supplements unreimbursed fees associated with emergency ambulance transportation services provided by public entities to Medicaid recipients enrolled in Medicaid Managed Medical Assistance (MMA) Plans. The proportionate fund allocation of PEMT IGT is derived from projections of supplemental support needed by ambulance service providers and the current year’s Medicaid managed care population; based on historical utilization. Situations whereby utilization falls below 5% of the projection would necessitate a return of a portion of the funds to AHCA; utilization above the projected amount would not result in an increase in funding. Pinellas County Emergency Medical Services has been invoiced for the IGT in the amount of $1,779,218.94 and is projected to receive an allocation in the amount of $4,617,749.65; which results in a net revenue of $2,838,530.71. The invoiced amount is required by AHCA as they must be in possession of the physical dollars in order to draw down Federal program funds. Providers must execute LOAs with MCOs in their corresponding region prior to receiving an allocation from PEMT IGT.
Background/Explanation:
AHCA implemented PEMT for ground transportation in 2015 which was limited to recipients not required to be enrolled in an MMA plan per Florida Statute 409.965. Approximately ninety percent (90%) of all Florida Medicaid recipients do not meet the requirements of this Florida Statute and are required to be enrolled in MMA Plans. On April 8, 2020, AHCA approved the expansion of the PEMT Program to include reimbursements for MMA recipients, via an IGT program.
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 expenditures associated with ambulance services to Medicaid recipients and involves the preparation of cost reports. PEMT IGT is a forward projection based on service needs and the number of Medicaid MMA plan enrollees in a specific region per year.
The PEMT and PEMT IGT programs are crucial revenue sources as Medicaid’s ambulance transportation reimbursement amounts have 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 cost for providing EMS transportation services in Pinellas County in FY19 was $329 per transport (fully loaded).
Fiscal Impact:
Net projected revenue of $2,838,530.71 is included in the FY20 estimate submitted as part of FY21 budget development.
Delegated Authority:
Authority for the County Administrator to sign these Letters of Agreement with Medicaid Managed Care Organizations is granted under Code Section 2-62 (a)(1). The LOA between AHCA and Pinellas County authorizing the dollar amount of the program was approved by the BOCC under Granicus 19-2371A.
Staff Member Responsible:
James G. Fogarty, Bureau Director, Safety & Emergency Services Department
Partners:
Agency for Health Care Administration (AHCA)
Medicaid Managed Medical Organizations (MCOs)
Attachments:
Six (6) MCO Letter of Agreements
Information Sheet from AHCA PEMT Uniform Increase Overview
OMB Analysis