HomeMy WebLinkAboutStaff Report 3.B 2/24/2014 Agend 'Iten ni#3 .3
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DATE: February 24, 2014
TO: Honorable Mayor and Members of the City Council through City Manager
FROM: Larry B. Anderson,Fire Chief
Jeff.Schach, Battalion Chief
SUBJECT: Agreement for Ground Emergency Medical Transport (GEMT) Medi-Cal
Reimbursement with the Sacramento Metropolitan Fire District
RECOMMENDATION
It is recommended that the City Council approve the attached Resolution authorizing the City
Manager to sign the Agreement for Recovery of Administrative Costs for Implementation and
Recovery of Ground Emergency Medical Transportation Payments with the Sacramento
Metropolitan Fire District.
BACKGROUND
Federal and State Insurance Programs (Medi-Care and Medicaid/Medi-Cal) reimburse Ground
Emergency Medical Transport (GEMT) providers for GEMT services provided to their insureds
at a mandated rate regardless of the amount a provider charges for its services, leaving an
unreimbursed balance on bills for GEMT services provided to those with Medi-Care or
Medicaid/Medi-Cal insurance coverage. Such contractual write-downs for unreimbursed GEMT
services are the largest portion of uncollected charges generated by the Petaluma Fire
Department. Other contractual write-downs occur in the cases of GEMT services to persons
whose medical coverage is provided through the Veterans Administration and persons with
Worker's Compensation claims, related to their use of GEMT services. In 2013, contractual
Medi-Care write-downs accounted for 34.41% of all of the Petaluma Fire Department's
uncollected GEMT charges; Medi-Cal write-downs accounted for 10.58%; and Others were
1.23%. The remainder of the uncollected charges and bad debt:write-offs are from non-insured
or underinsured persons who did not pay their ambulance bill and from whom the City was
unable to collect. Overall, the City's collection rate for 2013 was 45.13%. The industry
collection rates range from 30%-45%, depending on socio-economic factors and the payer mix
within the service area. Payer mix is the ratio of insurance coverage types of recipients of
GEMT services, including Medi-Cal, Medi-Care, private insurance and un-insured persons.
Nearly half(46.22%) ofwhatthe City billed in 2013 for GEMT services was not collectable due
to contractual write-downs. The City of Petaluma's net collection percentage rate for 2013,
Agenda Re w:
City Atm! N Finance Director City Manager
using the amount that the City could actually collect;after contractual Write-downs, is 83.91%, or
$1,710,714 in collections.
California. Welfare and Institutions Code 14105.94, enacted October 2, 2011, authorized the
Ground Emergency Medical Transportation (GEMT) Services, Supplemental Reimbursement
Program. This voluntary, certified public expenditure-based, program provides additional
funding to eligible governmental entities that provide GEMT;services to Medi-Cal beneficiaries.
The Centers for Medicare and Medicaid Services approved State Plan Amendment 09-24 on
September 4, 2013, authorizing the federal share of the supplemental reimbursement payments
based on uncompensated costs for Medi-Cal fee-for-service transports, effective January 30,
2010. With that important step, funding for this program is now in place.
DISCUSSION
Petaluma Fire Department currently provides service to Medi-Cal fee-for-service patients, but
with minimal reimbursement of costs by Medi-Cal. Entering into the GEMT Medi-Cal
Reimbursement program would, reimburse the City of Petaluma for half the difference between
what Medi-Cal provides as payment for a Medi-Cal-covered recipient of GEMT services and the
true cost of providing GEMT services.
Future and retroactive reimbursement periods under the GEMT Medi-Cal Reimbursement
Program' will be based on a fiscal year calendar. With the retroactive effective date being
January 30, 2010, the first year of the program only includes.5 months and 1 day of FY 09/10.
The other retroactive Fiscal Years of 10/11, 11/12 and 12/13 will include the entire fiscal year..
The work performed by the State for this program did not begin until after the enactment of
California Welfare and Institutions Code 14105.94 on October 2, 2011. For this reason, the
attached contract covers the years in which work was done on the program, even though
reimbursement goes back nearly a year and a half prior to the contract date.
For a publicly-owned GEMT service provider like the City'of Petaluma to be eligible for the
program, the following requirements must be met (as specified in CA Welfare and Institutions
Code § 14105.94). The service provider must have:
• Provided GEMT services to Medi-Cal beneficiaries (further defined in SPA 09-024);
• Be enrolled as a Medi-Cal provider for the period being claimed; and
• Be owned:or operated by an eligible governmental entity, to include the state, city,
county, city and county, fire protection district, special district, community services
district, health care district or a federally recognized Indian tribe as these laws are in
effect on January 30, 2010.
Eligible providers who choose to participate in the GEMT program must also:
• Enter into a Provider Participation Agreement (PPA) with the Department of Health
Care Services (DHCS). The City of Petaluma entered into such a PPA on October
15th, 2013;
• Agree to reimburse DHCS for their allocated share of the administrative costs
associated with overseeing the program; and
• Complete an Annual Participation Survey indicating their intention to participate in
the specified fiscal year's GEMT reimbursement program. This was completed
September 26, 2013.
The State Department of Health Care Services contracts with the.Sacramento Metropolitan Fire
District (the "District") to assist with the GEMT program, including the collection of
administrative costs. Each transporter's share of the costs of the reimbursement program will
differ in proportion to the number of reimbursable transports they provided. The State
anticipates the initial reimbursement share for the State's administrative costs incurred as a result
of the reimbursement program to average about $3 per transport of what the agency provided.
This cost per transport amount is based on an estimate of the State's administrative costs of
$475,000 and cumulative Statewide transports numbering 159,000 (total for all four years). An
additional 1% of each participating agency's gross State Supplemental Reimbursement of GEMT
services will be paid to the District for their administrative costs. All agencies that are
participating in this program must sign an agreement with the District (see Exhibit A to the
Resolution, attached). The City of Petaluma's estimated reimbursement amount for the four (4)
retroactive years is $50,466.68, and the City's share to be paid to the District under the
agreement to reimburse the District's administrative costs for those four (4) years is $428.40 (1%
of Petaluma's-gross State Supplemental Reimbursement of GEMT services). The City's share of
the cost of reimbursing the State for its program costs for the same period is $414.00 (about $3
per transport). On a recurring annual basis, the amount of annual supplemental Medical
reimbursements to the City, and corresponding charges for reimbursement of District and State
program costs, is estimated to be about 25-50% of the 4--year retroactive reimbursement total,
depending on the amount of supplemental Medical reimbursements the City receives.
FINANCIAL IMPACTS
GEMT service providers who are eligible to participate in this program will receive retroactive
and annual supplemental reimbursement payments. The supplemental reimbursement payment
is based on certified public expenditures that have already been incurred by the public GEMT
service provider. The reimbursement amount is 50% of the actual total certified costs (true actual
costs to provide the service), as defined in SPA 09-024, to provide the service. The City of
Petaluma's estimated reimbursement amount for the four (4) retroactive years beginning January
30. 2010 is $50,466:68.
Below is a graph displaying the estimates of retroactive;and recurring;reimbursement revenue to
the City through participation in this program.
Total.Fire I Estimated
Department I Reimuursement
Ambulance. Medi-Cal "fee for through GEMT
Fiscal Year Transports I, service"Transports 1 Program
09/10 3127 24 $9,004.10
10/11 I 3050 35 I $13,016.30
11/12 3120 23 $7,702.46
12/13 3092 56 I $20,743.82
Estimated One-Time Retroactive Reimbursement 550.466.68
Estimated'Recurring Reimbursemtent 510,000-520.000
ATTACHMENT
1. Resolution and Agreement.
H
RESOLUTION AUTHORIZING THE-CITY MANAGER
TOSIGN AN AGREEMENT WITH THE SACRAMENTO
METROPOLITAN'FIRE DISTRICT FOR RECOVERY OF
ADMINISTRATIVE COSTS FOR IMPLEMENTATION AND
RECOVERY OF SUPPLEMENTAL GROUND EMERGENCY
MEDICAL TRANSPORTATION (GEMT) PAYMENTS
WHEREAS, Federal and State insurance programs such as Medi-Care and
Medicaid/Medi-Cal, reimburse Ground Emergency Medical Transportation (GEMT) service
providers for the cost of providing services to insureds at mandated rates, resulting in
unreimbursed costs of service incurred by GEMT service providers such as the City of Petaluma
Fire Department; and
WHEREAS, although the City incurs substantial costs for unreimbursed GEMT services
(i.e., equal to approximately 46.22% of GEMT service billings for 2013), it can only
contractually bill and expect payment for a certain amount; and
WHEREAS, California. Welfare and Institutions Code section 14105.94, enacted
October 2, 2011, authorized the GEMT Services Supplemental Reimbursement Program (the
"Program") which provides additional reimbursement to eligible public agency GEMT service
providers to help reduce the unreimbursed costs of GEMT service providers; and
WHEREAS, as aMedi-Cal-enrolled, public agency GEMT service provider, the City of
Petaluma is eligible to participate in the Program; and
WHEREAS, by participating in the Program, the City may receive additional
reimbursement for GEMT services thereby reducing the City's unreimbursed GEMT service
costs for the period January 30, 2010 through December 31, 2013 by an estimated $50,466.68;
and
WHEREAS, the State has entered into an agreement with the Sacramento Metropolitan
Fire District to administer the Program, including providing reimbursements to eligible
participant GEMT agencies and recovering from such agencies costs of administering the
Program incurred by the State and Sacramento Metropolitan Fire District; and
WHEREAS, in order to participate in the Program,.eligible GEMT agencies must enter
into an agreement with the, Sacramento Metropolitan Fire District providing for payment of
supplemental. GEMT 'service cost:reimbursement and recovery of program administration costs
of the Sacramento Metropolitan Fire District and the State;
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Petaluma,
as follows:
1. The proposed agreement with Sacramento Metropolitan Fire District for recovery of
administrative costs for implementation and recovery of ground emergency medical
transportation payments which is attached to this resolution as Exhibit A is hereby
approved, and the City Manager is authorized to sign the agreement on behalf of the City.
I EXHIBIT "A"
AGREEMENTTFOR RECOVERY OF ADMINISTRATIVE COSTS
FOR IMPLEMENTATION AND RECOVERY OF GROUND EMERGENCY
MEDICAL TRANSPORTATION PAYMENTS
This agreement is made and entered into on this day of 201_
between the Sacramento Metropolitan Fire District, ("Metro Fire") a political subdivision
of the State of`California and, , ("GEMT Transporter").
WHEREAS, the.State Department of Health Care Services ("State") has
developed and is administering the Medi-Cal Ground Emergency Transportation
Supplemental Reimbursement Program pursuant to the California Welfare and
Institutions Code Section 14105.94 and State Plan Amendments 09=024; and,
WHEREAS, the State has entered into an agreement with Metro.Fire for
administrative services related,to the Medi-Cal Ground Emergency Transportation
Supplemental Reimbursement.Program pursuant to Welfare and Institutions Code
Section 14105.94 and State Plan Amendments 09-024,which agreement is attached
hereto as Exhibit A, and is incorporated as if set forth fully herein; and,
WHEREAS under Welfare and Institutions Code Section 14105.94 an eligible
provider of ground emergency medical transportation services may be entitled to
supplemental Medi-Cal reimbursement as set forth in those;provisions;and,
WHEREAS an eligible provider as described in the:afore mentioned section is
required to enter into.an agreement to reimburse the State for implementing and
administering the Supplemental Reimbursement Program as a condition of receiving
supplemental reimbursement pursuant to that section; and,
WHEREAS Metro Fire has been designated, by the contract attached as Exhibit
A, to recover the administrative and implementation costs required to be paid by eligible
providers under that section; and,
WHEREAS Metro Fire will incur administrative and other costs in connection with
billing GEMT Transporter for costs, and has assumed the risk of payment, or non-
payment of the costs from GEMT Transporter;
NOW1herefore,,the Parties enter into this contract for the purpose of setting forth
the agreement for payment of administrative costs by the eligible GEMT providers to
Metro-Fire, under the following terms and conditions.
I. PARTIES
Metro Fire is a designated agency for the collection of costs related to the GEMT
Supplemental Medi-Cal Reimbursement Program. GEMT Transporter is an eligible
provider of GEMT services as described in Welfare and Institutions Code Section
14105.94.
Page 1 of 6
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II. TERMS
This agreement shall be effective and commence as of July 1, 2011 and shall
end on June 30, 2014. However, GEMT transporter,acknowledges and agrees that cost
reports submitted by GEMT Transporters are subject to audit by the State of California
for a period of thirtysix (36) months from the date of submission of the reports by the
GEMT Transporter to the State of California. During that period of time, State
administrative costs as,defined in Welfare and Institutions Code 14105.94 will continue
to be incurred by the State for which the GEMT Transporter agrees to pay to Metro Fire
pursuant to paragraph IV below. The GEMT Transporter agrees to pay its transporter
share of administrative costs pursuant to paragraph V after the termination of this
agreement, whether this agreement is terminated by its term, or in the event GEMT
Transporter elects to terminate the agreement, or in the event that Metro Fire terminates
the agreement.
III. RATIFICATION
Where there has-been a need for Metro Fire to provide services essential to the
initial start-up of the GEMT program in the State of California,and where such services
have been provided prior to the date of execution of this agreement, both Parties agree
that the calculation, and payment, of services under this Agreement shall begin on July
1, 2011.
IV. SCOPE OF SERVICES AND RESPONSIBILITIES
Metro Fire will provide the following services:
A. Advance of GEMT administration costs to the State as provided by SPA
09-024 on behalf ofthe GEMT Transporter.
B. Assistance, to the State GEMT program on behalf of the GEMT
Transporters including:
a. Cost Report development
b. Information resource to the State and Federal governments
c. Program development to expand the scope of eligible costs
C. Assistance to the GEMT Transporter including:
a. Program guidance via telephone
b. Ombudsman services when needed
c. -Advocate.for reimbursements
d. Government relations
The GEMT Transporter will provide the following services:
A. Accurate reports of transports eligible under the GEMT program
B. Accurate record keeping and retention of records for a period of not less than
7 years
C. Provide all records upon request for audit purposes
Page 2 of 6
V. PAYMENT TERMS
,GEMT Transporter agrees to pay Metro Fire the;transporter's share of the State
administrative costs as defined in Welfare and Institutions Code Section 14105.94. The
GEMT transporter share will be based upon the administrative costs per fee for service
Medi-Caf.transport,,multiplied by the GEMT Transporter's number of fee for service
Medi-Cal transports,for.each reporting period. The administrative costs per fee for
service Medi-Cal transport will tie:determined by the State of California based on the
total administrative costs of the State in administering the GROUND EMERGENCY
MEDICAL TRANSPORTATION SERVICES SUPPLEMENTAL REIMBURSEMENT
PROGRAM divided by the total number of fee for service Medi-Cal transports statewide
by all participating transporter agencies for each reporting period. In addition, the GEMT
transporter will compensate Metro Fire one percent (1%) of the GEMT transporters
gross State Supplemental'Reirnbursement of GEMT services under Welfare and
Institutions Code Section 14105.94 for each reporting period for Metro Fire's program
services, administrative services, expansion of program for future reimbursements,
contracting services, other expenses, cost of advancing funds for the State, and the risk
of non-payment.
A. Metro Fire.will .notify, via email, the aniount.due under V of this
agreement by the GEMT Transporter once the amount is determined.
B. All amounts due'under this agreement will be paid via an ACH
electronic debit transaction initiated by Metro Fire?no sooner than 30 days
after the first notification is sent to the GEMT Transporter.
C. The GEMT Transporter will complete the attached Direct Payment
Authorization Formauthorizing Metro Fire to initiate the debit payment of the
amounts due to Metro Fire pursuant to this agreement.
1. It is the:responsibility of the GEMT Transporter to keep the Direct
Payment Authorization Form up to date with-the most current financial
institution information.
D. Non-payment,by the GEMT Transporter due to insufficient funds or other
reasons will result ina termination of the agreement pursuant to Provision XII.
1. The breach to this agreement may be,cured by: 1) having the
amount due plus any additional bank fees incurred by Metro Fire (if any)
available-in'thefinancial institution named on the Direct Payment
Authorization Form and 2) the-successful completion of the debit
transaction including additional banking fees.
2. The State will not provide GEMT supplemental reimbursements to
the GEMT Transporter without a valid Agreement for Recovery of
Administrative Costs for Implementation and Recovery of GEMT
Payments with Metro Fire.
Page 3 of 6
VI. REIMBURSEMENT COSTS ACKNOWLEDGMENT
The GEMT Transporter acknowledges and agrees that the compensation paid to
Metro Fire pursuant to'this agreement is intended to cover the costs for administering
the supplemental,reimbursement_program under Welfare and Institutions Code Section
14105.94 for,its costs under Welfare and Institutions Code Section 14105.94(d). The
compensation payable to Metro Fire is approved by the State, pursuant to the contract
between the State and Metro Fire as set forth in the contract attached as Exhibit A. The
GEMT Transporter hereby agrees to waive any claim, action, or challenge to the
payment method'for the collection of costs under Welfare and Institutions Code Section
14105.94(d), in the manner set forth in this agreement.
VII. DISPUTE RESOLUTION
In the event of a dispute between the Parties in the terms of this agreement as to
any issue arising under this.Agreement, the Parties agree to meet and negotiate in good
faith to resolve such dispute. This shall not limit the Parties'right to pursue any available
remedies at law or in equity.
VIII. MUTUAL INDEMNIFICATION
It is agreed that the GEMT Transporter shall defend, hold harmless and
indemnify Metro Fire, its officers, employees, and agents from any and all claims
liability, loss or expense (including reasonable attorney'fees) for injuries or damage to
any person and/or any property which arise out of the terms and conditions of this
Agreement and the negligent or intentional acts or omissions of the GEMT Transporter
and its officers, employees or agents. It is further agreed that Metro Fire shall defend,
hold harmless and indemnify the GEMT Transporter and its officers, employees, and
agents from any and all claims liability, loss or expense (including reasonable attorney
fees) for, injuries or damage to any person and/or any property which arise out of the
terms and conditions of this Agreement and the negligent or intentional acts or
omissions of Metro Fire, its officers, employees, or agents.
IX. SEVERABILITY
If any term, condition, or provision of this Agreement is held by a court of
competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions will
nevertheless continue in full force and effect, and shall not be affected, impaired or
invalidated in any way. Notwithstanding the previous sentence, if a decision by a court
of competent jurisdiction'invalidates, voids, or renders unenforceable a term, condition,
or provision in'this Agreement that is included in the purpose of this Agreement then the
Parties to'this.Agreement shall either amend this Agreement pursuant to Provision X. Or
it shall be terminated.
Page 4 of 6
10
X. AMENDMENT AND`WAIVER
Except as provided herein, no alteration, amendment, variation, or waiver of the
terms of this Agreement shall be valid unless made in writing and signed by both
Parties. Waiver by either party of any default, breach or condition precedent shall not
be construed as a waiver of any other default, breach or condition precedent, or any
other right hereunder.
XI. INTERPRETATION
This Agreement shall be deemed to have been prepared equally by both of the
Parties,
and the Agreement and its individual provisions shall not be construed or interpreted
more favorably for one party on the basis that the other party prepared it.
XII. TERMINATION
Either of the.Parties may terminate this Agreement upon thirty (30) days written
notice to the other party. Notice shall be deemed served on the date of mailing. GEMT
Transporters responsibility for administrative costs incurred by the State associated
with transporter costs reports and/or the State's audit of those costs shall survive the
termination of the agreement.
XIII. PRIOR AGREEMENTS
This Agreement constitutes the entire contract between Metro Fire and GEMT
Transporter regarding the subject matter of this Agreement. Any prior agreements,
whether oral or written,.between Metro Fire and GEMT Transporter regarding the
subject.matter of this Agreement are hereby terminated effective immediately upon full
execution of this Agreement.
XIV. INTEGRATION CLAUSE
This Agreement and any exhibits attached hereto shall constitute the entire
agreement among the Parties to it and supersedes any prior or contemporaneous
understanding or agreement with respect to the services contemplated, and may be
amended only by a written amendment executed by both Parties to this Agreement.
XV. CONTROLLING LAW
The,validity of this Agreement and its terms or provisions, as well as the rights
and duties of the Parties hereunder,the interpretation and performance of this
Agreement shall.be governed by the laws of the State of California.
Page 5 of 6
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SACRAMENTO METROPOLITAN FIRE DISTRICT
Signature:
Name: Scott Clough
Title: Assistant Chief
Date:
GEMT Transporter
Signature:
Name:
Title:
Date:
Page 6 of 6
1�
SIGNATURE ROUTING SHEET
FOR
AGREEMENT FOR RECOVERY OF ADMINISTRATIVE COSTS FOR
IMPLEMENTATION AND RECOVERY OF GROUND EMERGENCY MEDICAL
TRANSPORTATION PAYMENTS
(Agreement/Project Title)
Please keep the original of this document with the City Clerk's executed original of the contract.
CITY OF PETALUMA
City Manager
ATTEST:
City Clerk
APPROVED AS TO FORM:
City Attorney
APPROVED:
Department Director
APPROVED:
Risk Manager
APPROVED:
Finance Director ///���
file name_GtMT Reimbursement 13
Signature Routing Sheet (March 2013)