PUBLIC EMERGENCY MEDICAL TRANSPORTATION (PEMT)

PUBLIC EMERGENCY MEDICAL TRANSPORTATION (PEMT) SUPPLEMENTAL REIMBURSEMENT PROGRAM Florida Fire Chiefs’ Association Presentation April 2019

MEDICAID Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. In Florida the federal share is 61.1%. For every 1 spent by the state, or a local government within the state, the Federal government will reimburse the state 1.61 Cities, counties, and special purpose districts within the State of Florida provide emergency medical service care to Medicaid recipients.

EMERGENCY MEDICAL TRANSPORT COST VS. PAYMENT Provider payment for emergency medical transportation from billing is: Ambulance Service, Basic Life Support 136.00 Ambulance Service, Advanced Life Support 190.00 Advanced Life Support, Level 2 (ALS2) 250.00 The average cost to provide emergency medical transportation is between 800 and 1200.

PEMT PROGRAM Florida Fire Chiefs Association lobbied the legislature to allow Federal Share reimbursement for local government ambulance transport costs for fee for service patients. For Example: Emergency medical transport costs 1,000. State Medicaid provides payment of 190 Unreimbursed costs are 810 ( 1000- 190) Federal share is 494 (61.1% of 810) PEMT Program was established by the Agency for Health Care Administration (AHCA)

PARTICIPATION LIMITS Must be an emergency medical transport provider. Must be enrolled as a Medicaid Provider Must be owned or operated by an eligible governmental entity, to include the State, city, county, or fire protection district. Only covers Fee-for-Service Transports Does not cover recipients enrolled in a Florida Medicaid Managed Care Plan. Does not cover Dry-Run Services (non-transports)

CERTIFIED PUBLIC EXPENDITURE (CPE) Certified Public Expenditure (CPE) is mechanism used to obtain federal funds to compensate for unreimbursed cost for emergency medical transportation provided to Medicaid recipients who are not enrolled in a Florida Medicaid Managed Care Plan. The basis for the CPE program is found in federal regulation under 42 CFR 433.51 CPE program requires Federal Approval by the Centers for Medicare and Medicaid Services (CMS) Florida’s State Plan Amendment 4.19-B was approved by CMS on October 20, 2016 – and made retroactive to October 1, 2015.

REQUIREMENTS An eligible PEMT entity must do all of the following: Submit cost reports for the previous state fiscal year (July 1 to June 30) by November 30th using spreadsheet approved by AHCA. Certify that the claimed expenditures are eligible for Federal Financial Participation (FFP) Keep, maintain, and have readily retrievable any records required by AHCA or CMS for a minimum of seven years after the initial submission.

COST REPORT Must use spreadsheet approved by AHCA. Ten “tabs” must be completed. Example:

COMPLETING THE COST REPORT The Cost Report is very detailed and takes some time to complete the first time. Some agencies have completed it internally using the Finance Department’s assistance. Some agencies have contracted (6%-12%) with a third party consulting firm to help them complete the Cost Report. McKesson Corporation Public Consulting Group (PCG) EMS M/C

REIMBURSEMENT PAYMENTS Payment disbursement will be processed and disbursed prior to September 30th of the following state fiscal year. For example, a PEMT entity that submits a cost report (covering SFY 2016-17) by November 30, 2017, will have a payment disbursement prior to September 30, 2018. The target date for payment disbursement will be March 31st .

FY2018-19 EXAMPLE PAYMENTS West Palm Beach Fire Department - 241,769 Riviera Beach Fire Department - 122,059 Polk County Fire Rescue - 320,242 Palm Beach Gardens Fire Rescue - 57,391 Orlando Fire Department - 770,875 Miami -Dade Fire Rescue - 3,857,419 Leon County EMS - 139,518 Boynton Beach Fire Rescue - 113,283

FUNDING & DISBURSEMENTS SFY 16-17 Budget Allocation of 15 million Requests were for 19 million Initially disbursed 15 million, then additional 4 million SFY 17-18 Budget Allocation of 25 million, plus 10 million to retroactively cover FY16-17 costs Requests were for 26,774,000 Disbursed 25 million SFY 18-19 Budget Allocation of 35 million More than 80 Million in new funding provided for public EMS providers through PEMT Program

FUTURE ADD PARTICIPANTS 116 Governmental licensed ALS/T agencies providing 911 (emergency) service. 64 Governmental Providers participated in FY2018-19 PEMT Program – bring 27 million dollars back into their communities Almost half of the eligible providers are not participating in this program.

FUTURE MANAGED CARE 80 percent of all Florida Medicaid recipients are enrolled in a managed care plan – currently not covered by PEMT Program. The FFCA is seeking an expansion of the PEMT Program by an additional 250 million to include the unreimbursed costs for Medicaid Managed Care patients. Must be done through an Intergovernmental Transfer (IGT) process. Flat Rate of 1,445 per trip supplemental payment Likely done incrementally (Goal for FY19-20 is 50 mil.)

INTERGOVERNMENTAL TRANSFERS (IGT) For services provided under the Medicaid managed care program, the ambulance provider supplies the nonfederal share through an intergovernmental transfer (IGT). An IGT is the transfer of funds from one unit of government to another, in this case from the governmental ambulance provider to the state Medicaid agency. Ambulance Provider transfers 1.00 to the State, and the MCO’s send back 1.61 to the ambulance provider.

MCO PAYMENT POTENTIAL FOR TOP 20 PROVIDERS Pinellas County 35,614,730 Jacksonville Fire 17,368,898 Miami-Dade County 15,323,015 Polk County 12,218,128 Orange County 11,515,350 City of Miami 9,355,122 Hillsborough County 8,929,410 Palm Beach County 8,554,712 Volusia County 8,219,596 Lee County EMS 7,868,647 Brevard County City of Tampa 7,508,022 6,593,268 St Lucie County 6,581,834 Alachua 6,325,878 Leon County Lake EMS 5,596,713 5,242,246 Manatee 4,606,316 Fort Lauderdale 4,460,307 Broward Sheriffs Orlando Fire 4,365,313 3,759,289

QUESTIONS? MORE INFORMATION CAN BE FOUND AT: Florida Fire Chiefs Association https:// www.ffca.org/pemt-public-emergency-medical-transpor tation-supplemental-reimbursement-program Agency for Healthcare Administration http:// ahca.myflorida.com/medicaid/Finance/finance/LIP-DSH/ PEMT/index.shtml