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Chief Administrative Office, Emergency Medical Services and Emergency Preparedness and Response Division, recommending the Board:
1) Approve and authorize to Chair to sign funding Agreement 7071 with Sacramento Metropolitan Fire District, serving as a fiscal intermediary between the State and the County of El Dorado for the Supplemental Medi-Cal Reimbursement Program for ground emergency medical transport, with an effective date retroactive to July 1, 2022. This Agreement covers the period July 1, 2022 through June 30, 2023, and includes administrative costs based on 1% of the amount reimbursed by the State; and
2) Authorize the Deputy Chief Administrative Officer to execute any necessary amendments relating to Agreement 7071, excluding term extension and increases to the not-to-exceed amount, contingent upon approval by County Counsel and Risk Management.
FUNDING: CSA 3 and CSA 7.
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DISCUSSION / BACKGROUND
The Department of Health Care Services (DHCS) is the State agency responsible for administering the Medi-Cal Program, pursuant to Welfare and Institutions Code Section 14105.94. DHCS has obtained Federal approval to operate a Supplemental Reimbursement Program (Program) for Ground Emergency Medical Transportation (GEMT) Services provided by California ambulance providers. Under this Certified Public Expenditures Program, the County is eligible to receive reimbursement for approximately 50% of the total eligible expenditures for the provision of GEMT services to Medi-Cal fee-for-service patients.
The administrative costs of the Program must be borne by the ambulance providers benefiting from the program, including the County. The Program is operated by DHCS, who has entered into a contract with Metro Fire providing that Metro Fire advances funds to DHCS, and is subsequently reimbursed by other providers. Agreement 7071 provides for the reimbursement of Metro Fire by the County for the County’s share of the administrative costs of the Program. Additionally, 1% of total Program revenues are to be paid to Metro Fire to cover costs incurred as the fiscal intermediary.
Entering into this contractual relationship with Metro Fire is a requirement to participate in the Program.
Prior Agreement 036-S1810 (Agreement 78) with Metro Fire expired June 30, 2020, and was approved by the Board on August 8, 2017 on Legistar item 14-0332. In 2018, DHCS submitted Medicare State Plan Amendment (SPA) 18-007, requesting Federal approval of changes to the Program. While the SPA was under review, DHCS paused the acceptance of GEMT cost plan reports, and therefore the Program was put on hold. The SPA was never approved, however, the Centers for Medicare and Medicaid Services (CMS) approved DHCS to continue operating the program without the requested changes. DHCS recently began accepting GEMT cost reports again, and Fiscal Years 2018-2019 through 2021-2022 were all accepted within the past six months. Due to the pause in the GEMT program, Metro Fire had no administrative tasks to perform for a gap of several years. The recommended Agreement 7071, received from Sacramento Metro Fire on October 19, 2022 has an effective date that is retroactive to July 1, 2022 and runs through June 30, 2023. During the term of the Agreement, Program years 2018-19 through 2022-23 will be processed.
Due to recent legislation, the Program ceased to operate effective December 31, 2022, and will be replaced by a new GEMT program, which will not require a fiscal intermediary agreement with Metro Fire.
ALTERNATIVES
The Board could choose to not approve Agreement 7071, however, disapproval of this Agreement could result in the loss of an estimated $450,000 in supplemental Medi-Cal reimbursement for ambulance transportation services provided to Medi-Cal beneficiaries.
PRIOR BOARD ACTION
On August 8, 2017, the Board approved item 14-0332 authorizing the Chair to sign funding Agreement 036-S1810 (Agreement 78) with Sacramento Metropolitan Fire District, serving as the fiscal intermediary between the County of El Dorado and the State, for supplemental Medi-Cal reimbursement from the State for ground emergency medical (ambulance) transport for the period July 1, 2017 through June 30, 2020. This Agreement included administrative costs based on 1% of the amount reimbursed by the State.
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Counsel and Risk Management
CAO RECOMMENDATION / COMMENTS
Approve as recommended.
FINANCIAL IMPACT
CSAs 3 and 7 are expecting to receive a reimbursement of an estimated $450,000 for Fiscal Years 2020-2021 and 2021-2022. Based on historical data, we are expecting to pay an estimated $35,000 in fees for the term of the agreement. If the Board were to not approve this Agreement, it could result in the loss of an estimated $415,000 in supplemental Medi-Cal reimbursement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain Board Chair signature on Agreement 7071 and forward to CAO Fiscal, attention Kelley Lawrie.
STRATEGIC PLAN COMPONENT
Good Governance.
CONTACT
Sue Hennike, Deputy CAO
Michelle Patterson, Manager/EMS Agency Administrator.