TO: Honorable Mayor and Members of the City Council
THRU: Tom Kisela, City Manager
FROM: Sean deMetropolis, Fire Chief
1. Subject
title
Participate in a one-time Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer Program with the California Department of Health Care Services.
body
2. Summary
A request for City Council approval to participate in a one-time Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer Program for the twelve-month period ending December 31, 2025, to access additional Federal Medicaid dollars to support unreimbursed care.
3. Recommended Action
recommendation
Approve agreements with the California Department of Health Care Services in the amount of $1,100,000, plus a $110,000 assessment fee to the California Department of Health Care Services for managing the Public Provider Ground Emergency Medical Transportation program, payable in quarterly Intergovernmental Transfers; and authorize the Mayor and City Clerk to execute on behalf of the City.
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4. Fiscal Impact
Reimbursable funds of $1,100,000 will be used to obtain approximately $2,000,000 in previously unreimbursed Medicaid revenue add-ons, resulting in a net benefit of $900,000, and will be advanced through the General Fund (100) respectively: 100.1103.
5. Strategic Plan Goals
Goal 1: Provide for a Safe Community
b: Provide and maintain infrastructure necessary to ensure the safety of the public.
Goal 2: Be a Fiscally Healthy Community
b: Expend fiscal resources responsibly.
6. Discussion and Background
An Intergovernmental Transfer (IGT) allows California’s Medi-Cal Managed Care and Fee For Service plans to partner with local units of government to access additional Federal Medicaid dollars and use them to support unreimbursed care and provide health care services. The City has participated in IGT programs for Federal funds for unreimbursed care since 2014. In 2019, AB 1705 was signed into law, creating the Public Provider Ground Emergency Medical Transportation (PP-GEMT) program. Per transport, the total reimbursement under the new PP-GEMT IGT Program is higher than what was received historically under the existing GEMT Quality Assurance Fee (QAF) program, but the provider contribution through the IGTs is also expected to be higher than QAF payments when compared to a per transport basis. These contributions are voluntary; however, if the California Department of Health Care Services (DHCS) determines that the projected amount of voluntary contributions is not sufficient to support the implementation of the program, the program would not be continued in future rating periods. If the program ends, public GEMT providers would revert to reimbursement under existing programs, including the GEMT Certified Public Expenditure (CPE) Supplemental Payment Program (AB 678) and GEMT-QAF (SB 523).
Payments for this program will require four quarterly installments, with the first transfer due in January 2025. Estimates for Calendar Year (CY) 2025 PP-GEMT reimbursements provided by DHCS for Medi-Cal Managed Care and Fee For Service Plans are below.
|
IGT Contribution from City |
$1,100,000 |
|
10% Admin Fee |
$110,000 |
|
Total IGT Transfer to DHCS for CY 2025 Program |
$1,210,000 |
|
Estimated unreimbursed IGT Revenue available |
$2,110,000 |
|
Estimated Net Revenue |
$900,000 |
7. ATTACHMENTS
• Attachment 1 DHCS IGT Certification Form for CY 2025
• Attachment 2 DHCS CY 2025 Invoice #1
• Attachment 3 Assembly Bill 1705 (AB 1705)