Subject:
Title
Letter of Agreement with United Health Care, a Medicaid Managed Care Organization, 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 State of Florida Agency for Health Care Administration.
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Recommended Action:
Recommended Action
Approval and execution by the County Administrator of the letter of agreement (LOA) with a Medicaid Managed Care Organization (MCO) as a required implementation step to receive funding from the Medicaid Public Emergency Medical Transportation (PEMT) Intergovernmental Transfer (IGT) Program, which was authorized via a Letter of Agreement between Pinellas County and the Agency for Health Care Administration; Granicus Number 22-1674A.
• The LOA must be executed by Pinellas County initially and returned to the MCO. The LOA serves as a program mechanism to authenticate the relationship that currently exists between the ambulance service provider and the MCO. United Healthcare was not a Medicaid MMA plan when this program initially began.
• A LOA approved through Granicus 22-1674A, was executed with the Agency for Health Care Administration (AHCA) to participate in the FY 22-23 PEMT IGT Program that is estimated to generate net revenue of $6,834,381.20. Of this amount $1,112,613.20 will come from United Healthcare (UHC). Execution of this LOA with the UHC MMO is the last step necessary to receive the final FY22-23 reimbursement under this program.
• This was included in the FY23 Adopted budget within the EMS fund. The revenue has properly been accrued to FY23.
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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:
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.
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. United Healthcare was not a Medicaid MMA plan when this program initially began.
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 $137.96; Advanced Life Support $192.73; and Advanced Life Support, Level 2 (ALS2) $253.59.
Fiscal Impact:
Total projected net revenue of $6,834,381.20, of which $1,112,613.20 will come from United Health Care through this LOA. These amounts are consistent with the FY23 EMS fund adopted budget. This revenue has been accrued to FY23.
Delegated Authority:
Authority for the County Administrator to sign this Letter of Agreement with Medicaid Managed Care Organizations is granted via BOCC Resolution 23-18.
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:
One (1) MCO Letter of Agreement
Information Sheet from AHCA PEMT Uniform Increase Overview
BOCC Resolution 23-18
OMB Analysis