HomeMy WebLinkAboutStaff Report 3.K 12/07/2015DATE: December 7, 2015
Agenda Item #3.K
TO: Honorable Mayor and Members of the City Council through City Manager
FROM: Leonard C. Thompson, Fire Chief
Dave Kahn, Battalion Chief -Fire Administration
SUBJECT: Resolution Authorizing the City Manager to Sign 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
RECOMMENDATION
It is recommended that the City Council approve the attached Resolution Authorizing the City
Manager to Sign 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.
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.
However, this typically leaves 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.
California Welfare and Institutions Code 14105.94, enacted October 2, 2011, authorized the
Ground Emergency Medical Transportation 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 ( "SPA 09-
024") 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.
On February 24, 2014, City Council approved Resolution 14 -025 N.C.S., enabling the City to
join this reimbursement program and regain costs associated with Medi -Cal transports during
January 30, 2010 — June 30, 2013. It was considered a retroactive program because it allowed
for submittal of costs going back to 2010. The one -time retroactive reimbursement for Petaluma
was estimated to be $50,466.68. In fact, over the life of this program so far, the City has
received more than $77,339 in reimbursement. Participation in this program is cost - effective.
The new agreement for GEMT reimbursement will cover costs associated during the time period
of July 1, 2014 through June 30, 2017. In 2014, contractual Medi -Care write -downs accounted
for 33.95% of all of the Petaluma Fire Department's uncollected GEMT charges, Medi -Cal
write -downs accounted for 12.14% and those deemed as "Others" were 1.26 %. 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 fiom whom the City was unable to collect. Overall, the
City's collection rate for 2014 was 44.91 %. 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 uninsured persons. Nearly half (47.35 %) of what the City billed in
2014 for GEMT services was not collectable due to contractual write - downs. The City of
Petaluma's net collection percentage rate for 2014, using the amount that the City could actually
collect after contractual write- downs, was 85.30 %, or $1,763,881 in collections.
DISCUSSION
Petaluma Fire Department currently provides service to Medi -Cal fee - for - service patients, but
with minimal reimbursement of costs by Medi -Cal. Participating in the GEMT Medi -Cal
Reimbursement Program would continue to 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.
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
15, 2013;
• Agree to reimburse the Department of Health Care Services 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. An additional I% 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 (Exhibit A). The City of Petaluma's estimated
reimbursement amount for fiscal year 13/14 is $26,718. 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 3 -year
reimbursement total, to end on June 30, 2017, 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 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 amounts for FY 13/14 & 14/15 are displayed in the table below:
The remaining 2 fiscal years included in the Terms of this latest contract (FY 15/16 and 16/17)
have yet to occur, but anticipated reimbursement is expected to be between $10,000- $20,000
annually.
ATTACHMENT
1. Resolution and Agreement (Exhibit A).
Total PFD
Medi -Cal "Fee For
Estimated
Ambulance
Service"
Reimbursement thru
Fiscal Year
Transports
Transports
GEMT program
13/14
3,197
51
$26,718
14/15
3,103
82
$45,623.57
The remaining 2 fiscal years included in the Terms of this latest contract (FY 15/16 and 16/17)
have yet to occur, but anticipated reimbursement is expected to be between $10,000- $20,000
annually.
ATTACHMENT
1. Resolution and Agreement (Exhibit A).
ATTACHMENT 1
RESOLUTION AUTHORIZING THE CITY MANAGER
TO SIGN 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 47.35% of GEMT service billings for 2014), 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 a Medi - Cal - enrolled, public agency GEMT service provider, the City of
Petaluma is eligible to participate in the Program, and has already re- couped over $77,339 in
reimbursement by participating in this program during the period January 30, 2010 through June
30, 2014; and
WHEREAS, by participating in the Program, the City may receive additional similar
reimbursement for GEMT services thereby reducing the City's unreimbursed GEMT service
costs for the period July 1, 2014 through June 30, 2017; 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.
EXHIBIT "A"
AGREEMENT FOR 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 ( "State Code ") and State Plan Amendments ( "SPA ")
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 the State Code and SPA 09 -024
( "State Agreement "), which is attached hereto as Exhibit A, and is incorporated as if set
forth fully herein; and,
WHEREAS under the State Code 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 State Code 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'the State Code; and,
WHEREAS pursuant to the State Agreement, Metro Fire has been designated by
the State to recover the administrative and implementation costs required to be paid by
eligible providers under the State Code; 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;
NOW therefore, the Parties enter into this Agreement for the purpose of setting
forth the manner -and terms for payment of administrative costs by the eligible GEMT
providers to Metro Fire, under the following terms and conditions. -
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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 the State Code.
II. TERMS
This Agreement shall be effective and commence as of July 1, 2014 and shall end on
June 30, 2017. 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 thirty -six (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 the State Code will continue to be incurred by the
State for which the GEMT Transporter agrees to pay to Metro Fire pursuant to Section
IV below. The GEMT Transporter agrees to pay its transporter share of administrative
costs, pursuant to Section 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.
Ill. 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,
2014.
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 of the 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. General (offsite) program assistance
b. Ombudsman services when needed
c. Advocate for reimbursements
d. Government relations
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N
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
seven (7) years
C. Provide all records upon request for audit purposes
V. PAYMENT TERMS
GEMT Transporter agrees to pay Metro Fire the transporter's share of the State
administrative costs as defined in the State Code. The GEMT transporter share will be
based upon the administrative costs per fee for service Medi -Cal 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 be
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 transporter's gross State Supplemental
Reimbursement of GEMT services under the State Code 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 from GEMT Transporters.
A. . Metro Fire will notify, via email, the amount due under Section V. of this
Agreement by the GEMT Transporter once the amount is determined.
B. All amounts due under this Agreement will be paid to Metro Fire no
later than 30 days after the first notification is sent to the GEMT Transporter.
C. Non - payment by the GEMT Transporter constitutes a breach of this
Agreement and, if not cured, will result in a termination of this Agreement
pursuant to Section XII below.
1. A breach of this Agreement may be cured by the successful
completion of the payment transaction to Metro Fire by GEMT Transporter
within 30 days' notice by Metro Fire.
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.
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 Section 14105.94(d) of the State Code.
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The compensation payable to Metro Fire is approved by the State, pursuant to the State
Agreement 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
Section 14105.94(d) of the State Code, 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 Section X. Or it
shall be terminated.
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.
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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
Transporter's 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.
XI11. PRIOR AGREEMENTS
This Agreement constitutes the entire Agreement 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.
SACRAMENTO METROPOLITAN FIRE DISTRICT
Signature:
Amanda Thomas, Chief Financial Officer Date
GEMT Transporter
Signature:
Name:
Title:
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Date