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Health and Human Services Agency recommending the Board:
1) Approve and authorize the Chair to sign funding Agreement 036-S1810 (Agreement) 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, with an effective date retroactive to July 1, 2017. This Agreement covers the period July 1, 2017 through June 30, 2020, and includes administrative costs based on 1% of the amount reimbursed by the State; and
2) Authorize the Chair to execute further Amendments, relating to Agreement 036-S1810 that do not increase the administrative cost percentage or change the term of the Agreement, and contingent upon approval by County Counsel and Risk Management.
FUNDING: Medicaid Federal Financial Participation.
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DEPARTMENT RECOMMENDATION:
The Health and Human Services Agency (HHSA) recommends approval of Agreement 036-S1810 with Sacramento Metropolitan Fire District (Metro Fire) to serve as the fiscal intermediary between the State and the County of El Dorado. This funding Agreement provides federal Medicaid reimbursement (referred to as supplemental Medi-Cal reimbursement) for each ambulance transport provided to a Medi-Cal beneficiary. Additionally, Metro Fire receives an administrative fee of one percent (1%) based on the amount of supplemental Medi-Cal reimbursement for Ground Emergency Medical Transportation (GEMT) services the County receives from Metro Fire on behalf of the State.
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 14100.1. DHCS also administers the Ground Emergency Medical Transportation (GEMT) Services Supplemental Reimbursement Program (Program) specific to Medicaid (Medi-Cal in California) reimbursement and submits claims for Federal Financial Participation (supplemental Medi-Cal reimbursement) based on allowable expenditures for GEMT services under Federal law. The County receives approximately 50% of the total Medi-Cal rate reimbursement from the State for services provided to Medi-Cal beneficiaries who are transported by ambulance.
Entering into an Agreement with Metro Fire will allow the County to receive a supplemental payment of approximately 50% of the Federal Financial Participation (FPP). Metro Fire retains 1% of the supplemental reimbursement as an administrative fee, for acting as the fiscal intermediary and administering the agreement with DHCS. The County is required to contract with Metro Fire in order to receive supplemental Medi-Cal reimbursements through the GEMT program from the State. The supplemental reimbursement payment is based on certified public expenditures that have already been incurred by the County at 50% of allowable total certified costs, less previously reimbursed amounts.
Criteria to participate in the Program includes: (1) the County must provide GEMT services to Medi-Cal beneficiaries; (2) the County must be an enrolled Medi-Cal provider during the period being claimed; and (3) participants in the program must be owned or operated by an eligible governmental entity, including but not limited to counties. In addition, the County must: (1) enter into an Agreement with the fiscal intermediary, Metro Fire; (2) agree to reimburse Metro Fire for their allocated share of the administrative costs associated with overseeing the program; and (3) complete an Annual Participation Survey, when required. To continue to receive reimbursement, the County must annually complete a Cost Report and submit it to the Centers for Medicare and Medicaid Services.
The current Agreement (339-O1511) with Metro Fire expired June 30, 2017, and was approved by the Board on August 11, 2015 (File ID 14-0332, Item 13). The recommended agreement has an effective date that is retroactive to July 1, 2017 and runs through June 30, 2020. The effective date is retroactive due to the time required to negotiate edits to the contract per County Counsel direction.
ALTERNATIVES:
Disapproval of this Agreement 036-S1810 could result in the loss of an estimated annual $500,000 (based on historical data) in supplemental Medi-Cal reimbursement for ambulance transportation services provided to Medi-Cal beneficiaries.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel and Risk Management.
CAO RECOMMENDATION:
It is recommended that the Board approve this item.
FINANCIAL IMPACT:
There is no Net County Cost associated with this Agenda Item. Sufficient appropriations are included in the Fiscal Year 2017-2018 Budget, and will be included in future budgets for the term of the Agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain the signature of the Chair on two (2) originals of Agreement 036-S1810.
2) Clerk of the Board to return all documents to HHSA Contracts Unit at 3057 Briw Road, Suite B, to obtain final signature from Metro Fire.
STRATEGIC PLAN COMPONENT:
N/A
CONTACT
Patricia Charles-Heathers, Ph.D., Director