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Fire Department
DATE: October 15, 2013
TO: Honorable Mayor and City Council
FROM: Kurt Norwood, Acting Fire Chief
By: Yvonne Yeung, Senior Management Analyst
SUBJECT: AUTHORIZE AND DIRECT THE CITY MANAGER TO EXECUTE A
PROVIDER PARTICIPATION AGREEMENT WITH THE CALIFORNIA
DEPARTMENT OF HEALTH CARE SERVICES FOR THE MEDI -CAL
GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
SUPPLEMENTAL REIMBURSEMENT PROGRAM
Recommendation: Approve
SUMMARY
The Ground Emergency Medical Transportation Supplemental Reimbursement
Program, or GEMT, is a new State of California program that allows the City to apply for
Federal reimbursement to recoup partial expenses when providing emergency
ambulance transportation services to Medi -Cal patients. The City must enter into a
Provider Participation Agreement with the California Department of Health Care
Services in order to participate in the GEMT program and be eligible to receive Federal
funding. The City is anticipated to receive between $20,000 and $50,000 in
reimbursements each year from the program. It is recommended that the City Council
authorize and direct the City Manager to enter into a Provider Participation Agreement
with the California Department of Health Care Services for the GEMT program.
BACKGROUND
Annually, the City of Arcadia Fire Department provides emergency medical services and
emergency ambulance transportations for over 3,000 medical and rescue - related
incidents. The City has a mechanism in place to recover costs for the services
rendered. An emergency ambulance transportation bill can range from approximately
$1,100 for a minor medical incident to over $1,600 for an emergency in which advanced
life support measures were provided. These rates are consistent with those provided by
the Los Angeles County Emergency Medical Services Agency.
GEMT Agreement
October 15, 2013
Page 2 of 3
A small segment of the City's patient population is Medi -Cal beneficiaries. Medi -Cal is
California's medical welfare program —a public health insurance program, financed
equally by the State and Federal government, for low- income individuals. When the
Fire Department provides emergency ambulance transportation services to a Medi -Cal
patient, the City receives, on average, a payment of $150 from Medi -Cal for an
ambulance bill that is over $1,000. That small payment must be accepted by the City as
"payment in full."
DISCUSSION
Signed by Governor Brown in October 2011 and approved by the Federal government
in September 2013, the Ground Emergency Medical Transportation (GEMT)
Supplemental Reimbursement Program allows eligible governmental entities to apply
for Federal funding to fill a reimbursement gap left by the State when transporting Medi-
Cal patients. The program would authorize Federal dollars to pay for 50 percent of the
uncompensated costs for Medi -Cal fee - for - service transports, retroactive to January 30,
2010.
The GEMT program means additional ambulance billing revenues for the City; it is
estimated that the City will receive a one -time, retroactive payment of up to $125,000
from the program. Moreover, the GEMT is a fully funded program and it is anticipated
to generate between $20,000 and $50,000 per year for the City on an annual basis in
ambulance billing revenues. Annual reimbursement amounts will vary, depending on
the number of Medi -Cal beneficiaries the Fire Department transported in a given year.
To participate in the GEMT program, the City must enter into a Provider Participation
Agreement with the State's Department of Health Care Services. In addition, the City
must agree to pay the State a 1% administrative fee for overseeing the program. An
Annual Participation Survey must be completed every year to indicate the City's
intention to participate in the program, along with a complex cost report detailing the
actual direct and indirect expenditures incurred by the City when providing emergency
ambulance transportation services to Medi -Cal patients during the reporting year.
Within three years of submitting a cost report and receiving a reimbursement payment,
the State has the right to conduct a financial audit. Adjustments to the reimbursement
amount may be made if they are deemed justified by the results of the audit. According
to Sacramento Metro Fire District Chief Clough, the project lead of the GEMT program,
there will be no foreseeable impact on the City's ability to submit cost reports or receive
reimbursement payments as a result of the current shutdown of the Federal
Government.
GEMT Agreement
October 15, 2013
Page 3 of 3
FISCAL IMPACT
It is estimated that the GEMT program will generate one -time revenue of up to $125,000
for Arcadia for the retroactive period of January 30, 2010, through June 30, 2013.
Additionally, upon the successful completion and submission of an annual cost report,
the City is anticipated to receive between $20,000 and $50,000 every year from the
program. Actual annual reimbursement amounts will depend on the number of Medi-
Cal transports the Fire Department provided during the reporting year. Revenues
received from the GEMT program will be deposited into the City's Ambulance Charges
revenue account, 001 -3507.
RECOMMENDATION
It is recommended that the City Council authorize and direct the City Manager to
execute a Provider Participation Agreement with the California Department of Health
Care Services for the Medi -Cal Ground Emergency Medical Transportation Services
Supplemental Reimbursement Program.
Approved:
Dominic Lazzare
City Manager