HomeMy WebLinkAboutItem 06 Approval of Public Emergency Medical Transportation Letter of Agreement to Secure Funding for Unreimbursed Ambulance Costs for Medicaid Patients 10
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ocoee
florida
AGENDA ITEM COVER SHEET
Meeting Date: September 15, 2020
m #: (11
viewed By:
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Contact Name: , Fire Chief John M. M. ler Department Director: John Miller
Contact Number: 407-905-3140 City Manager: Robert Fra
Subject: Approval of Public Emergency Medical Transportation Letter of Agreeme to Secure Funding 9 y p 9 ,
for Unreimbursed Ambulance Costs for Medicaid Patients
Background Summary:
The State of Florida Agency for Health Care Administration (AHCA) has established a Medicaid supplemental program to
remediate Medicaid payment insufficiencies.The Florida Medicaid Managed Care Supplemental Payment Program
(known as the MCO)will allow qualifying government agencies that transport Medicaid managed-care patients via
ambulance to receive supplemental payment. In order to receive Federal share funding, intergovernmental transfers from
Public Emergency Medical Transportation (PEMT) providers are required to cover the State's share of the MCO program
prior to federal reimbursement.
It is proposed that the City enter into an Agreement with AHCA, with annual renewals,which will allow the Ocoee Fire
Department(OFD)to collect revenue to offset the expense of providing emergency medical transport to Medicaid
patients.
OFD transported over 2,913 patients in calendar year 2019. Of these, approximately 10.47%were Medicaid patients. In
2016,the State of Florida.created the PEMT Certified Public Expenditure (CPE) program to provide supplemental
payments to emergency medical transportation providers for Medicaid fee-for-service patients. In 2019,the Florida
Legislature expanded the PEMT program to include Medicaid managed care patients. In order to leverage the
approximately 60% Federal share, qualified agencies are required to provide the 40%State share through
intergovernmental transfers.The revenue from this program is expected to be received through the various Medicaid
managed care providers who have covered patients that have been transported to a hospital. OFD will need to establish
written agreements with each of the managed care providers.
Issue:
Should the Honorable City Commission approve the Letter of Agreement with AHCA, authorize the Mayor to
execute the AHCA Agreement and Letters of Agreement with Medicaid managed providers, as well as their.
applicable annual renewals, and also authorize an intergovernmental transfer of funds not to exceed $27,882.15
in order to participate in the PEMT MCO program?
Recommendations:
Staff recommends the approval of the Letter of Agreement with AHCA, the authorization of the Mayor to execute
the AHCA Agreement and Letters of Agreement with Medicaid managed providers, as well as their applicable
annual renewals, and also the authorization of an intergovernmental transfer of funds not to exceed $27,882.15,
in order to participate in the PEMT MCO program.
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Attachments:
Public Emergency Medical Transportation Letter of Agreement
Sample Letter of Agreement with a Managed Care Provider
Financial Impact:
If approved, the City will remit through an intergovernmental transfer an amount not to exceed $27,882.15 to
AHCA, in order to receive a projected $45,319.54 in federal share dollars, plus be reimbursed the $27,882.15 in
state share dollars that are initially transferred, for an estimated total of$73,143.22. The Fire Department FY
2021 requested budget includes $27,882.15 to cover the fees. In no case is there a negative financial impact to
the City.
Type of Item: (please mark with an `k)
E Public Hearing For Clerk's Dept Use:
❑ Ordinance First Reading Consent Agenda
❑ Ordinance Second Reading Public Hearing.
❑ Resolution ❑ Regular Agenda
El Commission Approval
❑ Discussion& Direction
• Original Document/Contract Attached for Execution by City Clerk
❑ Original Document/Contract Held by Department for Execution
Reviewed by City Attorney
Reviewed by Finance Dept. c,p
Reviewed by
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Public Emergency Medical Transportation Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day of 2020, by and between City of Ocoee on behalf of City of Ocoee Fire
Department, and the State of Florida, Agency for Health Care Administration (the"Agency"),
for good and valuable consideration, the receipt and sufficiency of which is acknowledged.
DEFINITIONS
"Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid
governmental entity(e.g., counties, municipalities, hospital taxing districts, providers operated by
state or local government)to the Medicaid agency. IGTs must be considered a bona fide donation
pursuant to 42 CFR §433.54.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
"Public Emergency Medical Transportation (PEMT)," pursuant to the General Appropriation Act,
Laws of Florida 2019-115, is the program that provides supplemental payments for eligible
Public Emergency Medical Transportation (PEMT) entities that meet specified requirements and
provide emergency medical transportation services to Medicaid beneficiaries.
A. GENERAL PROVISIONS
1. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2020-2021,
passed by the 2020 Florida Legislature, the City of Ocoee and the Agency agree that
the City of Ocoee will remit IGT funds to the Agency in an amount not to exceed the
total of $27,882.15.-The City of Ocoee and the Agency have agreed that these IGT
funds will only be used for the PEMT program.
2. The City of Ocoee will return the signed LOA to the Agency no later than October 1,
2020.
3. The City of Ocoee will pay IGT funds to the Agency in an amount not to exceed the total
of$27,882.15. The City of Ocoee will transfer payments to the Agency in the following
manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2020 thru
June 2021 are due to the Agency no later than October 31, 2020 unless an
alternative plan is specifically approved by the agency.
b. The Agency will bill the City of Ocoee when payment is due.
City of Ocoee_City of Ocoee Fire Department_PEMT LOA_SFY 2020-2021
1. The City of Ocoee and the Agency agree that the Agency will maintain necessary
records and supporting documentation applicable to charity care health services covered
by this LOA in accordance with public records laws and established retention schedules.
a. AUDITS AND RECORDS
i. The City of Ocoee agrees to maintain books, records, and documents (including
electronic storage media) pertinent to performance under this LOA in accordance
with generally accepted accounting procedures and practices, which sufficiently
and properly reflect all revenues and expenditures of funds provided.
ii. The City of Ocoee agrees to assure that these records shall be subject at all
reasonable times to inspection, review, or audit by state personnel and other
personnel duly authorized by the Agency, as well as by federal personnel.
iii. The City of Ocoee agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The City of Ocoee agrees to retain all financial records, supporting documents,
statistical records, and any other documents (including electronic storage media)
pertinent to performance under this LOA for a period of six (6) years after
termination of this LOA, or if an audit has been initiated and audit findings have not
been resolved at the end of six (6) years, the records shall be retained until
resolution of the audit findings.
ii. Persons duly authorized by the.Agency and federal auditors shall have full access
to and the right to examine any of said records and documents.
iii. The rights of access in this section must not be limited to the required retention
period but shall last as long as the records are retained.
c. MONITORING
i. The City of Ocoee agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the City of Ocoee which are
relevant to this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The City of Ocoee agrees to neither assign the responsibility of this LOA to
another party nor subcontract for any of the work contemplated under this LOA
without prior written approval of the Agency. No such approval by the Agency of
any assignment or subcontract shall be deemed in any event or in any manner to
provide for the incurrence of any obligation of the Agency in addition to the total
dollar amount agreed upon in this LOA. All such assignments or subcontracts shall
be subject to the conditions of this LOA and to any conditions of approval that the
Agency shall deem necessary.
City of Ocoee_City of Ocoee Fire Department_PEMT LOA_SFY 2020-2021
1. The City of Ocoee and the Agency agree that any modifications to this LOA shall be in
the same form, namely the exchange of signed copies of a revised LOA.
2. The City of Ocoee confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to re-
direct any portion of these aforementioned charity care supplemental payments in order
to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
3. The City of Ocoee agrees the following provision shall be included in any agreements
between the City of Ocoee and local providers where IGT funding is provided pursuant to
this LOA. "Funding provided in this agreement shall be prioritized so that designated IGT
funding shall first be used to fund the Medicaid program and used secondarily for other
purposes."
4. This LOA covers the period of July 1, 2020 through June 30, 2021 and shall be terminated
June 30, 2021.
5. This LOA may only be amended upon written agreement signed by both parties.
6. This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fully binding on any party signing at least one
counterpart.
7. The City of Ocoee agrees to indemnify and hold harmless the Agency against any and all
liability related to a finding by CMS or the federal government that the IGT transfer, or
source of funds transferred, did not comply with the Medicaid state plan, Title XIX of the
Social Security Act, or any state or federal regulations or policies implementing Title XIX
of the Social Security Act, including but not limited to Section 1903(w) of the Social
Security Act; 42 C.F.R. Part 433, subpart B; and Centers for Medicare & Medicaid
Services' ("CMS") State Medicaid Director Letter #14-004 (May 9, 2014). This
indemnification would extend to any completed, actual, pending or threatened action, suit,
claim or proceeding brought by CMS or the federal government based upon a demand or
disallowance of any amount, including amounts relating to supplemental payments. The
City of Ocoee shall timely reimburse the Agency's reasonable legal fees and costs with
respect to any proceeding related to whether the IGT transfer, or source of funds
transferred, violated the Medicaid state plan, Title XIX of the Social Security Act, or any
state or federal regulations or policies implementing Title XIX of the Social Security Act.
The City of Ocoee will also be liable and financially responsible in the event of that a
demand or disallowance of any amount is found to be due and owing on this basis.
City of Ocoee_City of Ocoee Fire Department_PEMT LOA_SFY 2020-2021
PEMT Local Intergovernmental Transfers
Program /Amount State Fiscal Year 2020-2021
Minimum Fee Schedule/MCO IGTs $27,882.15
Total Funding $27,882.15
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
City of Ocoee STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: BY:
NAME: NAME:
TITLE: TITLE:
DATE: DATE:
City of Ocoee_City of Ocoee Fire Department_PEMT LOA_SFY 2020-2021
CITY:
CITY OF OCOEE, FLORIDA
By:
Rusty Johnson, Mayor
Attest:
Melanie Sibbitt, City Clerk
(SEAL)
APPROVED BY THE CITY OF OCOEE
COMMISSION AT A MEETING HELD
ON , 20_UNDER
AGENDA ITEM NO.
FOR USE AND RELIANCE ONLY BY
THE CITY OF OCOEE, FLORIDA.
Approved as to form and legality
this day of ,20_
Shuffield, Lowman& Wilson, P.A.
By:
City Attorney
Letter of Agreement
This Letter of Agreement ("LOA") is made and entered into on the day of
2019 by and between (Government Owned Emergency Medical Service
(EMS) Provider) and (Medicaid Managed Care Organization
(MCO)) (herein referred to collectively as "Parties").
WHEREAS, the Medicaid MCO has been awarded a contract by the Agency for Health
Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an
1115 Managed Medical Assistance Waiver(the"Waiver")in Region ,which includes
County where Government Owned EMS Provider is located and/or operates;
WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying
entity and provides out of network emergency medical services to MCO enrollees in Region
on an as needed basis, when the transport and treatment is appropriate; and
WHEREAS, the Centers for Medicare and Medicaid Services ("CMS") approved section
438.6 directed payments based on the establishment of a uniform increase to be paid to qualifying
Government Owned EMS Providers for the provision of emergency medical services to Medicaid
eligible persons enrolled in managed care organizations pursuant to the Waiver, which includes
the Medicaid MCO.
NOW THEREFORE, Government Owned EMS Provider and the Medicaid MCO do
hereby agree to the following:
1. Government Owned EMS Provider agrees to make emergency medical services available
to MCO's Medicaid enrollees on an as needed basis, when the transport and treatment is
appropriate.
2. Medicaid MCO shall receive per member per month section 438.6 directed payments for
care and treatment provided by the Government Owned EMS Provider,which the Medicaid
MCO shall timely remit to the Government Owned EMS Provider in accordance with
AHCA's contractual requirements.
3. Contact information for the parties is as follows:
Name: Name:
Title: Title:
Phone: Phone:
Email: Email
4. The Parties agree any modification to the LOA shall be in the same form, namely the
exchange of signed copies of a revised LOA.
5. This LOA covers the period of October 1, 2019 through June 30, 2024 unless terminated
sooner by the termination of section 438.6 directed payments.
IN WITNESS WHEREOF, the Parties have duly executed this LOA on the day and year above
first written. Each party represents that: (i) it has the authority to enter into this Agreement; and
(ii)that the individual signing this Agreement on its behalf is authorized to do so.
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER
NAME &TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE
MEDICAID MANAGED CARE ORGANIZATION
NAME &TITLE OF AUTHORIZED INDIVIDUAL
SIGNATURE OF AUTHORIZED INDIVIDUAL
DATE