Agenda Item Name:
Title
2020-21 State of Florida Public Emergency Medical Transportation (PEMT) Program
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Presenter:
Harold Theus, Chief 352-384-3101
Description:
Resolution and Budget Amendment for the 2020-21 State of Florida Medicaid Fee for Service, Managed Care Payment and Intergovernmental Transfer Program
Recommended Action:
Recommended Action
Adopt the Resolution, approve the budget amendment, approve the Emergency Medical Services Matching Grant application and authorize staff to electronically submit the Assistance to Firefighters Grant Application
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Prior Board Motions:
N/A
Fiscal Consideration:
Fiscal Consideration
The County will be providing the State share through an intergovernmental transfer (IGT). The IGT will require the County to provide the State share, approximately $482,320.00 (001.54.5450.526.49.00), which will result in approximately $1,267,920.00(001.54.5450.334.20.00) of additional Managed Care Option (MCO) patient transport revenue. The net unanticipated revenue for the MCO is $785,600.00. The unanticipated revenue for the Fee for Service (FFS) is $267,940.00 (001.54.5450.334.20.00). Staff recommends an allocation of $50,000.00 for the Fireground Physical Agility Test (FPAT) equipment (001.54.5450.526.52.00), $150,000.00 for light technical rescue equipment (001.54.5450.526.52.00), $450,000.00 Grant Match (001.54.5450.526.64.00), $323,540.00 for an additional rescue unit apparatus and equipment (001.54.5450.526.64.00), and $80,000.00 for anticipated compensation to Public Consulting Group (PCG) payment (6% for MCO and 12% for FFS) for their assistance in collecting the additional revenue (001.54.5450.526.34.00)
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Background:
Alachua County Fire Rescue transports approximately 32,500 patients annually generating collections of approximately $12 million per year from Medicare, Medicaid, private commercial insurance companies and individual payers. Of the total patients transported each year, almost 14 percent are covered by Medicaid. The average reimbursement for the services per Medicaid patient transport is $173.28. This amount is significantly lower when compared to reimbursements from Medicare, approximately $404.67 per patient transport, and patients with private health insurance, approximately $413.22 per patient transport.
Since 2016, Alachua County has participated in the Florida Public Emergency Medical Transportation (PEMT) Managed Care Reimbursement Program. This supplemental funding was established to help close the gap between cost incurred to provide services and revenue received for each emergency medical transport provided to a Medicaid fee for service patient. This was the first step to address the challenge of current Medicaid reimbursement rates.
In 2020 the Legislature authorized expansion of the program to include the Medicaid Managed Care population. The Medicaid Managed Care Supplemental Payment Program requires each participant to provide the state share, approximately 60%, through an Intergovernmental Transfer (IGT). The County was reimbursed by Medicaid Managed Care providers when their covered patients are transported to the hospital. In FY20, the County received an additional $1,422,752.01 of revenue and had a corresponding appropriation of $548,186.35 for the IGT to the Agency for HealthCare Administration (AHCA) to provide the 40 percent state share. The County realized $874,565.66 net additional revenue.
In 2021, the estimated additional revenue is $1,267,920.00 which will require a corresponding IGT to AHCA of $482,320.00 for a net additional revenue estimate of $785,600. This is a decrease over 2020 due to more Florida Counties participating in the program.
The estimated additional revenue from the PEMT Fee for Service program is $267,940.00. The total net combined unanticipated revenue increase is $1,053.540.00.
The Department requests $50,000 for the purchase of FPAT equipment and licenses, $150,000.00 for light technical rescue equipment, $450,000.00 to provide local grant match for the replacement of extrication equipment and purchase of automatic chest compression devices (ACCD) for our rescue units, $323,540.00 for an additional rescue unit apparatus and equipment and $80,000.00 for anticipated compensation to PCG payment for their assistance in collecting the additional revenue.
FPAT $50,000.00:
Alachua County Fire Rescue has utilized the Candidate Physical Abilities Test (CPAT) through the National Testing Network for years as a pre-hire qualification to move forward to the interview section of the hiring process. The CPAT is a validated test that has been used by fire departments for over 25 years with no change in the validation of the test. Through our experience with utilizing the physical test, we have seen a documented trend on its elimination of the smaller framed applicant. It is of our belief that there are more currently validated tests that will assess job function that is more suitable for today’s fire service and we have found that in the Fireground Physical Abilities Test (FPAT). The Fireground Physical Ability Test is a job simulation physical ability test, designed by Industrial Organizational Solutions (IOS) in partnership with FireSled Fitness, for assessing essential physical abilities of firefighter applicants and incumbent firefighters. In order to be used by any fire service agency for applicant selection or incumbent assessment, the FPAT must be locally validated and certified by IOS. We believe that this test will further help diversify our applicant pools, cut down the cost to the applicant being that we can provide the test in house, accurately assess and applicant’s physical capabilities to perform as a firefighter and serve as multi-use equipment being used for applicants, incumbents, Cadets, public education, training, etc. The test equipment and fee estimate is $50,000.00. The recurring cost will be dependent on the number of future applicants and will range between $500 and $2000. No additional funds will be requested to cover the recurring costs.
Light Technical Rescue Equipment $150,000.00:
Alachua County Fire Rescue is an all hazards department that is dedicated to enhancing and caring for the lives of those in our community through preparedness and an immediate response to any and all of life’s emergencies. As such, a key component is the ability to respond to hazards that require expertise to mitigate that can only be found with a Light or Heavy Technical Response component. Light and Heavy Rescue Teams are a multi-disciplined units/teams that are capable of conducting search, rescue and recovery. The timely response of this resource is predicated on having both the personnel and equipment ready, and available, for immediate action should the need arise. The need for this resource within Alachua County is essential for a rapid, coordinated response to the many areas of the County that may require this specialized type of response. These areas include, I-75, US 441, US 301, Paynes Prairie, Santa Fe River, area lakes, cave systems and the numerous trails.
Some of the situational uses of Light and Heavy Rescue Teams are:
• Tower Rescue
• Life Safety Rope Rescue
• Structural Collapse Rescue
• Confined Space Rescue
• Vehicle Rescue
• Animal Technical Rescue
• Wilderness Search and Rescue
• Trench Rescue
• Heavy Machinery/Industrial Rescue
• Cave Rescue
• Mine and Tunnel Rescue
• Surface Water Rescue
• Swiftwater Rescue
• Watercraft Rescue
• Floodwater Rescue
The team could also conduct post disaster damage assessments, be utilized for local or regional responses, and as a force multiplier when attached to a strike team on local, regional or state-wide deployments. The non-tangible benefits of such a team is that it showcases Alachua County Fire Rescue as being part of the state-wide disaster mitigation response and cements the Departments place as an all hazards organization that is prepared for immediate response within the community it serves as well as the surrounding communities and State. It is also a recruitment and retention tool that will attract individuals interested in becoming part of a multi-discipline team with specialized response capabilities. Provides continuing education to current employees broadening their scope of practice and better preparing them for any hazard they may face while keeping them engaged.
Grant Match $450,000.00:
The Department is currently preparing two grant applications (Emergency Medical Services Matching Grant and Assistance to Firefighters Grant) to replace critical extrication equipment and purchase automatic chest compression devices (ACCD) for our rescue units. Both grant applications require a local match. The Department recommends designating $450,000.00 as grant match. If the grants are not successful, staff will submit a spending plan for the funds to address equipment needs within Fire Rescue. The grant application deadlines are February 12, 2021. Staff recommends authorizing the chair to execute the Emergency Medical Services Matching Grant and authorizing staff to electronically submit the Assistance to Firefighters Grant.
Rescue Unit Apparatus and EMS Equipment $323,540.00:
Fire Rescue will be submitted a FY2022 budget request for an additional 24-hour rescue unit. In anticipation of it being funded by the Board, staff recommends the allocation of $250,000.00 for the apparatus and $73,540.00 for the EMS equipment (stretcher, monitor, etc.). If the unit is not funded in FY2022, staff recommends the funds be reallocated in the budget process to address unfunded Capital Improvement projects.
The resolution authorizes the participation in the supplemental payment program and amends the FY21 Adopted budget for the unanticipated revenue and expenditures. The program may require additional agreements with AHCA and Manager Care Providers. The resolution authorizes the Manager to execute those agreements. PCG has provided support in compiling the data and submitting the funding requests to obtain additional PEMT revenues. The existing agreement with PCG would allow them to continue these efforts and provide assistance for the Medicaid Managed Care Payment Program at a cost of 6% and Fee for Service Payment Program at a cost of 12% for a total estimated cost of $80,000.00.
On December 10, 2019, the Board approved the 2019-20 State of Florida Medicaid Managed Care Payment and Intergovernmental Transfer Program