HomeMy WebLinkAbout2023-07-25; City Council; ; Payment to Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer ProgramCA Review __AF__
Meeting Date July 25, 2023
To: Mayor and City Council
From: Scott Chadwick, City Manager
Staff Contact: Jennie Marinov, Senior Management Analyst
jennifer.marinov@carlsbadca.gov, 442-339-2135
Subject: Payment to Public Provider Ground Emergency Medical Transportation
Intergovernmental Transfer Program
Districts: All
Recommended Action
Adopt a resolution authorizing the city’s participation in the Public Provider Ground Emergency
Medical Transportation Intergovernmental Transfer Program with the Department of Health
Care Services, the City Manager or designee to execute certification forms and related program
documents and to make intergovernmental transfers in support of the program and the Deputy
City Manager, Administrative Services or designee to appropriate $468,000 in program revenue
and expenses annually to the General Fund.
Executive Summary
The state program that reimburses the City of Carlsbad for some of the cost of providing
emergency medical transports to Medi-Cal beneficiaries has been changed. As part of
establishing this updated reimbursement program, the state Department of Health Care
Services is requesting provider agencies to contribute Non-Federal specified amounts that will
then be largely matched by federal funds through the Centers for Medicare and Medicaid
Services.
The Fire Department is asking the City Council to authorize its participation in the new program
and to appropriate $468,000 in program revenue and expenses to the General Fund to be
utilized for program participation. The department will then make quarterly payments to
support the program, which is expected to bring the city about $883,000 in gross ambulance
reimbursement revenue providing a net increase of $415,000. These federal funds partially
offset the city’s cost of emergency ambulance transports for Medi-Cal beneficiaries. This is
significantly more than the city would receive under the previous programs.
The City Council’s approval is required to authorize the city’s participation in the
intergovernmental transfer of funds.
July 25, 2023 Item #5 Page 1 of 7
Explanation and Analysis
The Fire Department provides emergency medical transport services to patients enrolled in
Medi-Cal health care plans. In return, the city receives $118 for each transport as
reimbursement from the state. These payments do not cover the full cost of providing the
emergency medical transport, which is generally around $2,600.
A 2019 state law, California Assembly Bill 1705 – Medi-Cal: emergency medical transportation
services, was intended to ensure that all public agencies that provide these services would be
reimbursed for more of their costs for Medi-Cal transports. In accordance with AB 1705, the
Department of Health Care Services developed the Public Provider Ground Emergency Medical
Transportation Program, which replaced previous reimbursement programs as of Jan. 1, 2023.
The legislation prohibits the use of state funds in this new program and relies on voluntary
contributions from participating agencies to secure federal matching funds.
•The non-federal share of the Public Provider Ground Emergency Medical Transportation
Intergovernmental Transfer Program must be funded through contributions by eligible
public providers, as permitted by federal law for federal fund matching.
•All such contributions are voluntary.
•All public providers will receive these supplemental reimbursements under this
program.
The voluntary contributions made by intergovernmental transfers allow the state to secure the
federal matching funds that are the basis for providing the supplemental payments for Medi-
Cal transports. Without these voluntary contributions, the state will not have adequate funds to
access the matching federal funds and the program will end. The state would then revert to
previous ground emergency medical transportation reimbursement programs, which provide
less reimbursement for these transports.
These payments support the program’s long-term success, providing increased ambulance
reimbursement revenue from the federal government for the Carlsbad Fire Department and
other public ambulance providers.
The Department of Health Care Services provided local agencies with preliminary estimates of
what their voluntary contributions and federal reimbursements would be. The contribution
share estimates were based on the initial program participation interest levels and the
projected number of transports for each contributing agency and calculated as a percentage of
all projected transports across all contributing entities. The estimates also include a 10%
percent administrative fee for program administration.
Agencies are to make payments on their contributions on a quarterly basis. An agency must
submit a certification form before submitting each quarterly contribution, or intergovernmental
transfer. This certification form is attached as Exhibit 2 for reference. The form certifies that
funds are eligible for use as voluntary contributions to support the non-federal share of Medi-
Cal expenditures.
Fiscal Analysis
The Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer
Program will generate more reimbursement than previous reimbursements programs. The new
program provides higher supplemental reimbursements and applies to more transport types
July 25, 2023 Item #5 Page 2 of 7
including Medi-Cal Fee-For-Service, Medi-Cal Managed Care, and dual benefit transports
covered by both Medi-Cal and Medicare.
Annual program costs and benefits will fluctuate based on the number of Medi-Cal transports
provided by the city from year to year. The number of agencies contributing to the program’s
funding will also affect how much agencies will be asked to voluntarily contribute, the greater
the participation, the lower the individual contributions.
Based on these initial factors, the Department of Health Care Services estimated the city’s
annual voluntary contribution to be $468,000, with the city receiving $883,000 in gross
ambulance reimbursement revenue. This results in a $415,000 gain, roughly $200,000 more
than the city would receive under the previous reimbursement programs.
No additional funding is needed to participate in the reimbursement program, the intake and
outtake of funds nets to an overall increase to ambulance revenue.
Net ambulance revenue of $415,000 was included in the city’s adopted fiscal year 2023-24
budget. In future years, staff would like to record the full revenue and expense of this
reimbursement program separately, rather than as a net increase to ambulance revenue. To
accomplish this, staff are requesting an ongoing appropriation of $468,000 in both revenue and
expense to the General Fund starting in fiscal year 2023-24.
Next Steps
With City Council approval, the Deputy City Manager, Administrative Services will appropriate
$468,000 for the reimbursement program’s revenue and expenses. The City Manager or
designee will execute certification forms and remit payment to the Department of Health Care
Services on a quarterly basis. The city will continue to receive supplemental reimbursements for
eligible Medi-Cal transports.
Environmental Evaluation
This action does not constitute a project within the meaning of the California Environmental
Quality Act under California Public Resources Code Section 21065 in that it has no potential to
cause either a direct physical change or a reasonably foreseeable indirect physical change in the
environment.
Exhibit
1.City Council resolution
2.Certification form example
July 25, 2023 Item #5 Page 3 of 7
RESOLUTION NO. 2023-211
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD,
CALIFORNIA, AUTHORIZING THE CITY'S PARTICIPATION IN THE PUBLIC
PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION
INTERGOVERNMENTAL TRANSFER PROGRAM WITH THE DEPARTMENT OF
HEALTH CARE SERVICES, THE CITY MANAGER OR DESIGNEE TO EXECUTE
CERTIFICATION FORMS AND RELATED PROGRAM DOCUMENTS AND MAKE
INTERGOVERNMENTAL TRANSFERS IN SUPPORT OF THE PROGRAM AND
THE DEPUTY CITY MANAGER, ADMINISTRATIVE SERVICES OR DESIGNEE TO
APPROPRIATE $468,000 IN PROGRAM REVENUE AND EXPENSES ANNUALLY
TO THE GENERAL FUND
WHEREAS, the City of Carlsbad Fire Department provides emergency medical transport services
to patients enrolled in Medi-Cal health care insurance plans; and
WHEREAS, the City participates in various governmental programs that provide reimbursement
to help offset uncompensated costs for Medi-Cal transports; and
WHEREAS, pursuant to California Assembly Bill 1705 (Chapter 544, Statues of 2019), the
Department of Health Care Services developed the Public Provider Ground Emergency Medical
Transportation Intergovernmental Transfer Program to provide increased add-on supplemental
reimbursements for emergency medical transports provided by eligible providers; and
WHEREAS, by participating in the new program, the City will receive reimbursements covering
a larger proportion of its actual costs for providing emergency medical transport services to Medi-Cal
patients; and
WHEREAS, under the Department of Health Care Services Public Provider Intergovernmental
Transfer Program for Ground Emergency Medical Transportation Services Certification Form, the funds
shall be transferred in accordance with a mutually agreed-upon schedule between the City of Carlsbad
and Department of Health Care Services.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as
follows:
1.That the above recitations are true and correct.
2.That the City of Carlsbad Fire Department is hereby authorized to participate in the
Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer
Program with the Department of Health Care Services.
Exhibit 1
July 25, 2023 Item #5 Page 4 of 7
3.That the City Manager or designee is hereby authorized to execute the Department of
Health Care Services Public Provider Intergovernmental Transfer Program for Ground
Emergency Medical Transportation Services Certification Forms.
4.That the City Manager or designee is hereby authorized to make quarterly
intergovernmental transfers to the Department of Health Care Services to fund the non
federal expenditure portion of the reimbursement program.
5.That the Deputy City Manager, Administrative Services or designee is hereby authorized
to appropriate annual ongoing funding of $468,000 in program revenue and expenses
to the General Fund starting in fiscal year 2023-24.
PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City Council of the City of
Carlsbad on the 25th day of JJ:!.!y, 2023, by the following vote, to wit:
AYES:
NAYS:
ABSTAIN:
ABSENT:
Blackburn, Bhat-Patel, Acosta, Burkholder, Luna.
None.
None.
None.
KEITH BLACKBURN, Mayor
� L SHERRY FREISINGER, City Clerkv-(SEAL)
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July 25, 2023 Item #5 Page 5 of 7
DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
CERTIFICATION FORM FOR STATE CALENDAR YEAR 2023
I, the undersigned, hereby declare and certify on behalf of ______________________ (the “Public Entity”) as follows:
1.As a public administrator, a public officer, or other public individual, I am duly au-
thorized to make this certification.
2.The Public Entity elects to make this intergovernmental transfer (IGT) to the De-partment of Health Care Service (DHCS) as a voluntary contribution to the non-federal share of Medi-Cal expenditures for purposes of Assembly Bill 1705 (2019)
pursuant to Sections 14105.94, 14105.945, 14129, 14129.3, and 14164 of the Wel-
fare and Institutions (W&I) Code. All funds transferred pursuant to this certificationqualify for federal financial participation (FFP) pursuant to Section 1903(w) of theSocial Security Act and Title 42 of the Code of Federal Regulations, Section 433Subpart B, and are not derived from impermissible sources such as recycled Med-
icaid payments, federal money excluded from use as the non-federal share, im-
permissible health care-related taxes, or non-bona fide provider-related donations.
3.Voluntary contributions attributable to the period of January 1, 2023, through De-cember 31, 2023, will be made via recurring transfers as indicated on the invoices
provided to the Public Entity by DHCS. The Public Entity acknowledges that any
transfers made pursuant to this certification during this time period are consideredan elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to beused by DHCS, subject to paragraph four herein, exclusively as the source for thenon-federal share of ground emergency medical transport public provider supple-
mental payments in both Medi-Cal fee-for-service payments and the portion of the
risk-based capitation rate to Medi-Cal managed care health plans associated withreimbursement made in accordance with Section 14105.945, subdivision (h)(1)(hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Trans-portation (GEMT) Intergovernmental Transfer (IGT) Program, or the PP-GEMT
IGT Program), and DHCS costs associated with administering the PP-GEMT IGT
Program.
4.DHCS may accept this voluntary contribution to the extent it is able to obtain FFPfor the PP-GEMT IGT Program as permitted by federal law. In the event DHCS isunable to obtain FFP for the PP-GEMT IGT Program, or the full payments cannot
otherwise be made to and retained by eligible public providers, and, therefore, all
or a portion of the transferred amount cannot be used as the non-federal share ofpayments, DHCS will notify the Public Entity via e-mail and return the applicableportion of the unused IGT amount, no later than 90 days after such notification.
5.The Public Entity acknowledges that, in accordance with W&I Code section
14105.945, subdivision (h)(2), upon CMS approval, DHCS shall assess a ten per-
cent (10%) fee on each transfer of public funds to the state to pay for health care
Exhibit 2
July 25, 2023 Item #5 Page 6 of 7
DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
CERTIFICATION FORM FOR STATE CALENDAR YEAR 2023
coverage and to reimburse DHCS its costs associated with administering the PP-GEMT IGT Program.
6.The Public Entity acknowledges that the IGT is to be used by DHCS for the filing
of a claim with the federal government for federal funds and understands that any
misrepresentation regarding the IGT may violate federal and state law.
7. The Public Entity acknowledges that all records of funds transferred are subjectto review and audit upon DHCS’ request. The Public Entity will maintain docu-
mentation supporting the allowable funding source of the IGTs.
8.Upon notice from the federal government of a disallowance or deferral related tothis IGT, the Public Entity responsible for this IGT shall be the entity responsiblefor the federal portion of that expenditure.
I hereby declare under penalty of perjury under the law of the United States that the fore-
going is true and correct to the best of my knowledge. I further understand that the known filing of a false or fraudulent claim, or making false statements in support of a claim, may violate the Federal False Claims Act or other applicable statute and federal law and may be punishable thereunder.
Executed on this ______ day of _________, 20XX at __________________, California.
Signature of Authorized Person: __________________________________________
Name of Authorized Person: _____________________________________________
Title of Authorized Person: ______________________________________________
Name of Public Entity: _______________________________________________
NPI of Public Entity: _______________________________________________
Amount of IGT: $X.XX
July 25, 2023 Item #5 Page 7 of 7