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FROM:
CITY OF
NEWPORT BEACH
City Council Staff Report
January 23, 2024
Agenda Item No. 13
HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
Jeff Boyles, Fire Chief - 949-644-3101, [email protected] PREPARED BY: Raymund Reyes, Administrative Manager - 949-644-3352, [email protected]
TITLE: Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2024
ABSTRACT:
In 2019, Governor Gavin Newsom signed Assembly Bill No. 1705 (AB 1705) into law, authorizing the replacement of existing Medi-Cal Quality Assurance Fee (QAF) and Ground Emergency Medical Transport (GEMT) reimbursement programs with a single program under a new Public Provider GEMT Intergovernmental Transfer (PP-GEMT-IGT) process. The PP-GEMT-IGT program is voluntary and is dependent on the participation of all transport agencies for the program to be successful. The City of Newport Beach participated in the inaugural, 2023 program and received payments in the form of add -on fees for Medi-Cal reimbursements. Revenues received to date have surpassed the City's original contribution amount and are on track to match the original revenue projection.
The Fire Department is requesting continued participation for Calendar Year 2024.
RECOMMENDATIONS:
a) Determine this action is exempt from the California Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) and 15060(c)(3) of the CEQA Guidelines because this action will not result in a physical change to the environment, directly or indirectly; b) Approve the City of Newport Beach's voluntary participation in the PP-GEMT-IGT program per AB 1705 for Calendar Year 2024 and authorize the City Manager to execute the Public Provider Intergovernmental Transfer Program for Ground Emergency Medical Transportation Services Certification Forms and pay all necessary invoices; and
c) Approve Budget Amendment No. 24-045 increasing anticipated revenues in 01040404-431027 by $1,159,970 and appropriating $210,882.69 in increased expenditures in Account No. 01040404-821010 (PP-GEMT-IGT) for Fiscal Year 2023- 24 to make the first two estimated payments to the State under the PP-GEMT-IGT program for Calendar Year 2024.
DISCUSSION:
The Medi-Cal program is the State's Medicaid program. Administered by the Department of Health Care Services (DHCS), Medi-Cal provides qualified Californians with healthcare services. Medi-Cal coverage can extend to Emergency Medical Services (EMS), including those provided by the City's Fire Department.
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Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2024
January 23, 2024
Unlike patients with private insurance (or, in most cases, Medicare), Medi-Cal patients do not have a co -pay and medical providers like the City must accept Medi-Cal payments as payment in full.
Medi-Cal is partially governed and funded by federal Medicaid provisions. Medi-Cal plan holders account for approximately 10% of all City medical transports. The City is reimbursed for EMS services directly from the State's Medi-Cal program. Medi-Cal has only paid a capitated base rate of $118.20 per transport since 1999, which is significantly lower than the actual costs for the City to provide these services. DHCS' Quality Assurance Fee (QAF), Ground Emergency Medical Transport (GEMT), and Intergovernmental Transfer (IGT) programs provide additional revenue to help offset the cost of service.
AB 1705 implemented a new Medi-Cal Public Provider Intergovernmental Transfer Program (PP-GEMT-IGT) for public ground emergency medical transportation providers.
Passed in 2019 but not implemented until 2023, this program replaced the QAF and GEMT programs and provides additional payments to public providers who transport eligible Medi-Cal patients.
PP-GEMT-IGT is funded by a combination of ambulance transport agency funds and a federal (CMS) match, called a Federal Financial Participation (FFP). The State of California will not allow State general funds to be utilized for this reimbursement program, so the program requires that public ambulance providers voluntarily provide the State with the amount needed (approximately $110 million) through an Inter -Governmental Transfer (IGT). DHCS then uses the non-federal funds to draw down available matching federal funds and uses the combined sum to pay the add -on amount per eligible Medi-Cal transport. DHCS manages the reimbursement program and charges an administrative fee of 10% of the non-federal share amount.
With the add -on payments included in each transport bill resulting from AB 1705, the total payment for the transport of Medi-Cal patients is now $1,065.12 and represents a significant increase from the $220.80 add -on fee received under the prior QAF program.
The City Council approved participation in the inaugural, Calendar Year (CY) 2023 program on June 13, 2023. Based on the amounts received to date and pending amounts forthcoming, the program appears to be successful. Staff requests City Council approval to participate in the CY 2024 program.
FISCAL IMPACT:
The CY contribution for 2023, including the 10% administrative fee, was originally estimated to be $443,776. The City has contributed $399,377 in CY 2023 payments to DHCS to date. DHCS has not yet invoiced participating agencies the administrative fee amount. As of January 2024, the City has received $461,373 in add -on fees for CY 2023 Medi-Cal transports, with $697,021 pending collection, bringing the current total revenue to $1,158,394. December 2023 billings have not yet been processed; there may be additional revenue beyond the $697,021 pending amount.
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Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2024
January 23, 2024
PP-GEMT-IGT ADD -ON FEES FOR CY 2023
Add -On Fees Collected
Pending add -on amount
PP-GEMT--IGT Revenue
$461,373
$697,021
$1,158,394
CY 2023 Original
Estimate
CY 2023 Actual
Total Revenue
$1,181,208
$1,158,394
City PP-GEMT-IGT
Contribution
-$403,433
-$399,377
DHCS 10% Admin Fees
-$40,344
-$39,968 (pending
invoice)
Net Revenue:
$737,431
$719,049
To participate as a funding entity for CY 2024, the City must transfer local funds up to an estimated total contribution amount of $421,766. This again includes the 10% administrative fee to DHCS. It is important to note that depending on total agency participation, the actual payment amounts due during the year may be higher or lower.
Based on the current DHCS figures and the number of possible transports, the City may expect to receive a total of $1,155,655 from the CY 2024 program, resulting in an approximate net revenue of $733,889.
The Budget Amendment appropriates $210,882.69 in increased expenditure appropriations from the General Fund unappropriated fund balance for payments into the PP-GEMT-IGT program in the first two quarters of 2024. The two remaining payments in July and October 2024 will be incorporated into the fiscal year 2024-25 adopted budget.
The Budget Amendment also recognizes $1,044,405 in FY2023-24 for amounts received in the current fiscal year for the CY 2023 program, and an estimate of $115,565 for amounts expected to be received in the current fiscal year for the CY 2024 program, totaling $1,159,970. As a result, there is a net increase in fund balance for the General Fund of $949,087 for FY 2023-24.
ENVIRONMENTAL REVIEW:
Staff recommends the City Council find this action is not subject to the California Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) of the CEQA Guidelines, California Code of Regulations, Title 14, Chapter 3, because it has no potential for resulting in physical change to the environment, directly or indirectly.
NOTICING:
The agenda item has been noticed according to the Brown Act (72 hours in advance of the meeting at which the City Council considers the item). 13-3
Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2024
January 23, 2024
ATTACHMENTS:
Attachment A — PP-GEMT-IGT Certification for Calendar Year 2024 Attachment B — Department of Health Care Services Invoice Attachment C — Budget Amendment No. 24-045
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ATTACHMENT A
DEPARTMENT OF HEALTH CARE SERVICES
PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR
GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
CERTIFICATION FORM FOR STATE CALENDAR YEAR 2024
I, the undersigned, hereby declare and certify on behalf of the City of Newport Beach (the "Public Entity") as follows:
1. As a public administrator, a public officer, or other public individual, I am duly authorized to make this certification.
2. The Public Entity elects to make this intergovernmental transfer (IGT) to the Department 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 Welfare and Institutions (W&I) Code. All funds transferred pursuant to this certification qualify for federal financial participation (FFP) pursuant to Section 1903(w) of the Social Security Act and Title 42 of the Code of Federal Regulations, Section 433 Subpart B, and are not derived from impermissible sources such as recycled Medicaid payments, federal money excluded from use as the non-federal share, impermissible health care -related taxes, or non -bona fide provider -related donations.
3. Voluntary contributions attributable to the period of January 1, 2024, through December 31, 2024, 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 considered an elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to be used by DHCS, subject to paragraph four herein, exclusively as the source for the non-federal share of ground emergency medical transport public provider supplemental 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 with reimbursement made in accordance with Section 14105.945, sub- division (h)(1) (hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Transportation (GEMT) Program, or the PP-GEMT Program), and DHCS costs associated with administering the PP-GEMT Program.
4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP for the PP-GEMT Program as permitted by federal law. In the event DHCS is unable to obtain FFP for the PP-GEMT 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 of payments, DHCS will notify the Public Entity via e-mail and return the applicable portion of the unused IGT amount, no later than 90 days after such notification. 13-5
DEPARTMENT OF HEALTH CARE SERVICES
PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR
GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
CERTIFICATION FORM FOR STATE CALENDAR YEAR 2024
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 percent (10%) fee on each transfer of public funds to the state to pay for health care coverage and to reimburse DHCS its costs associated with administering the PP-GEMT 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 amount voluntarily transferred to DHCS is based on the estimated Medi-Cal fee -for -service and Medi-Cal managed care non-federal share of ground emer- gency medical transport public provider supplemental payments, as referenced in paragraph three herein. Because the amount to be voluntarily transferred to DHCS will be based on an estimate, the Public Entity acknowledges that a reconciliation of the voluntary non-federal share contributions to the actual non-federal share expenditures will occur. To the degree necessary to fund the non-federal share for the PP-GEMT Program, amounts due to or owed by applicable Public Entities as a result of the reconciliation may be offset against, or added to, future transfers as applicable and as determined by DHCS. DHCS may accept a voluntary contribu- tion to the extent it is able to obtain FFP for PP-GEMT payments as permitted by federal law.
8. The Public Entity acknowledges that all records of funds transferred are subject to review and audit upon DHCS' request. The Public Entity will maintain documentation supporting the allowable funding source of the IGTs.
9. Upon notice from the federal government of a disallowance or deferral related to this IGT, the Public Entity responsible for this IGT shall be the entity responsible for the federal portion of that expenditure.
I hereby declare under penalty of perjury under the law of the United States that the foregoing 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.
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DEPARTMENT OF HEALTH CARE SERVICES
PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR
GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
CERTIFICATION FORM FOR STATE CALENDAR YEAR 2024
Executed on this day of January, 2024 at Newport Beach, California.
Signature of Authorized Person:
Name of Authorized Person: Grace K. Leung
Title of Authorized Person: City Manager
Name of Public Entity: City of Newport Beach
NPI of Public Entity: 1679579296
Amount of IGT: $95,855.77
APPROVED AS TO FORM:
CITY ATTORNEYS OFFICE
Date:
# # # 1/�' 4
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By:
ron C. Harp, City Attorney 1 /Z4 w�-
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ATTACHMENT B
PzjoHCS
CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES
Michelle Baass I Director
PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM
MANAGED CARE AND FEE FOR SERVICE - INVOICE
Provider Name:
City Of Newport Beach
NPI:
1679579296
Vendor Name:
California Department of Health Care Services
PP-GEMT Program Email:
[email protected]
Year: 2024 Collection #: 1
Total Amount Due: $95,855.77
Bank Name:
US Bank
Please await Wire Request Memo for payment instructions ACH or Wire Transfer
Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification by January 1, 2024, to [email protected].
IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions.
Please do not send your IGT payment until you have received the Wire Request Memo as payment details are subject to change.
Managed Care (MC)
Fee For Service (FFS)
MC NFS #1
MC Admin Fee #1
0:20131-131
FFS Admin Fee #1
Total* IGT Transfer Amount:
*Any differences are due to rounding.
$86,271.07
$0.00
$9,584.70
$0.00
$95,855.77
CY 2024
Invoice #1
Invoice Packets Sent
1211/2023
IGT Certifications Due
111/2024
Paynient Due
1f 15/2024
CY 2024
Invoice #2
Invoice Packets Sent
311/2024
IGT Certifications Due
411/2024
Payment Due
4/IS/2024
CY 2024
Invoice #3
Invoice Packets Sent
5/31/2024
IGT Certifications Due
711/2024
Payment Due
7/15/2024
CY 2024
Invoice #4
Invoice Packets Sent
S/30f2024
IGT Certifications Due
1011/2024
Payment Due
10/15/2024
c ylp°?T� ATTACHMENT C
City of Newport Beach
BUDGET AMENDMENT
2023-24 BA#: 24-045
Department: Fire
ONETIME: ❑ Yes ❑ No
Requestor: Raymund Reyes
Approvals
❑ CITY MANAGER'S APPROVAL ONLY
Finance Director: Date f f jD
0 COUNCIL APPROVAL REQUIRED City Clerk: Date
EXPLANATION FOR REQUEST:
Payment to State of California for Participation in PP-GEMT-IGT for State Calendar Year 2024 and to recognize ❑ from existing budget appropriations received amounts for the CY 2023 program and CY 2024 program. 0 from additional estimated revenues ❑ from unappropriated fund balance
REVENUES
Fund #
Org
Object
Project
Description
Increase or (Decrease) $
010
01040404
431027
PG123
EMERGENCY MEDICAL SERVICES -
1,044,405.00
010
07040404
431027
PG124
EMERGENCY MEDICAL SERVICES -
115,565.00
Subtotall $ 1,159,970.00
EXPENDITURES
Fund #
Org
Object
Project
Description
Increase or (Decrease) $
010
01040404
821010
EMERGENCY MEDICAL SERVICES - PP-GEMT-IGT
210,882.69
Subtotal $ 210,882.69
FUND BALANCE
Fund #
Object
Description
Increase or (Decrease) $
010
300000
GENERAL FUND - FUND BALANCE CONTROL
949,087.31
Subtotal $ 949,087.31
Fund Balance Change Required
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