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 2023-24 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) 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 Agency for Health Care Administration (AHCA) prior to October 1, 2023.
• 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.
• Projected net revenue is $13,926,233.74 to the Emergency Medical Services Fund in Fiscal Year (FY) 2024.
• This will have a positive fiscal impact on Pinellas County. The FY24 proposed budget includes gross revenues budgeted at $7,964,520.00. During the FY24 budget development cycle, it was not known that AHCA would receive a substantial increase in appropriation for 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:
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 a cost report. 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 that 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 $10,101,084.65 and to receive an allotment in the amount of $24,027,318.39 resulting in net revenue of $13,926,233.74.
The public entities are required to execute an annual LOA and IGT in the amount invoiced by AHCA. 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/Explanation:
Reimbursement for ambulance transportation services for Medicaid recipients has remained stagnant for decades, currently at: Basic Life Support $137.96; Advanced Life Support $192.73; and Advanced Life Support, Level 2 (ALS2) $253.59. 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 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 original 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.
Fiscal Impact:
Projected net revenue of $13,926,233.74 to support the EMS Fund.
Total distributions received from MMA plans are projected at $24,027,318.39, which will be offset by a projected expenditure of $10,101,084.65, resulting in net revenue of $13,926,233.74. These numbers reflect current program projections from AHCA that are subject to change.
Based on historical actuals, the IGT transfer was included in the FY24 proposed budget at $4,728,000 and the Gross Revenues were budgeted at $7,964,520.00. The significant increase in the IGT may necessitate a budget amendment to recognize and appropriate the increased revenue and expenditure. During the FY24 budget development cycle, it was not known that AHCA would receive a substantial increase in appropriation for this program.
Delegated Authority:
Authority for the County Administrator to sign this agreement is granted under Resolution No. 23-18.
Staff Member Responsible:
Jim Fogarty, Bureau Deputy Director, Safety & Emergency
Partners:
Florida Agency for Health Care Administration (AHCA)
Various Managed Medical Organizations
Attachments:
Public Emergency Medical Transportation Letter of Agreement (LOA)
Year 5 SFY 2023-2024 PEMT MCO Allotments