Agenda Item
City Council
Item #: 3.22. 1/10/2023 File #: 23-0011
TO: Honorable Mayor and Members of the City Council
THRU: Tom Kisela, Interim City Manager
FROM: Susan Galvan, Assistant City Manager
1. SUBJECT
Participate in a one-time Public Provider Ground Emergency Medical Transportation (PP-GEMT) Intergovernmental Transfer (IGT) Program with the California Department of Health Care Services.
2. SUMMARY
A request for City Council approval to participate in a one-time Public Provider Ground Emergency Medical Transportation (PP-GEMT) Intergovernmental Transfer Program with the California Department of Health Care Services for the twelve-month period ending December 31, 2023, to access additional Federal Medicaid dollars to support unreimbursed care.
3. RECOMMENDED ACTION
Approve participation with the California Department of Health Care Services in the total amount of $1,114,313, plus a $111,431 assessment fee to be advanced quarterly to the California Department of Health Care Services for managing the PP-GEMT program, and authorize the Mayor and City Clerk to execute on behalf of the City.
4. FISCAL IMPACT
Total reimbursable funds of $1,225,744 will be advanced on a quarterly basis to obtain previously unreimbursed Medicaid revenue of approximately $2,596,565 in add-on payments, resulting in a net benefit of $1,370,821. Funds are available in the General Fund (100).
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
a: 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 of unreimbursed care since 2014. In 2019, AB 1705 was signed into law creating the Public Provider Ground Emergency Medical Transportation (PP- GEMT) program. PP-GEMT replaces both the SB523 Quality Assurance Fee (QAF) program which City of Orange Printed on 1/5/2023Page 1 of 3
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Item #: 3.22. 1/10/2023 File #: 23-0011
GEMT) program. PP-GEMT replaces both the SB523 Quality Assurance Fee (QAF) program which provided an add-on reimbursement, and the annual Ground Emergency Medical Transport (GEMT) program. Due to the increased reimbursement available with PP-GEMT, the City will have a higher rate of cost recovery compared to participation in the SB523 QAF and GEMT programs. PP-GEMT participation is voluntary: if there are not enough funds Statewide to fund the IGT to match federal funds, PP-GEMT will end and the City would revert to participating in the SB523 and annual GEMT programs.
The City indicated its voluntary participation in the program with the California Department of Health Care Services (DHCS) in the October 18, 2022 Letter of Intent. On a quarterly basis, DHCS will invoice the City and provide the corresponding reimbursement with the city’soriginal payment plus the IGT of additional Medicaid dollars.
Estimates for CY 2023 PP-GEMT reimbursements provided by the California Department of Health Care Services for Medi-Cal Managed Care and Fee For Service Plans are below:
CY 2023 Medi-Cal Managed Care
Total Projected Revenue
$ 2,336,676
Requested IGT
(1,025,470)
10% admin fee
(102,547)
Managed Care Net Benefit
$ 1,208,659
CY 2023 Medi-Cal Fee For Service
Total Projected Revenue
$ 259,889
Requested IGT
(88,843)
10% admin fee
(8,884)
Fee For Service Net Benefit
$ 162,162
City of Orange Printed on 1/5/2023Page 2 of 3
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Item #: 3.22. 1/10/2023 File #: 23-0011
CY 2023 Medi-Cal Managed Care
Total Projected Revenue
$ 2,336,676
Requested IGT
(1,025,470)
10% admin fee
(102,547)
Managed Care Net Benefit
$ 1,208,659
CY 2023 Medi-Cal Fee For Service
Total Projected Revenue
$ 259,889
Requested IGT
(88,843)
10% admin fee
(8,884)
Fee For Service Net Benefit
$ 162,162
7. ATTACHMENTS
· Letter of Intent to DHCS
· DHCS Managed Care Estimated CY 2023 Net Benefit Calculation · DHCS PP-GEMT IGT Net Benefit email
City of Orange Printed on 1/5/2023Page 3 of 3
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