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Home My WebLink About08 - Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) PaymentQ SEW Pp�T CITY OF z NEWPORT BEACH c�<,FORN'P City Council Staff Report March 28, 2023 Agenda Item No. 8 TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL FROM: Jeff Boyles, Fire Chief - 949-644-3101, jboyles@nbfd.net PREPARED BY: Raymund Reyes, Administrative Manager, rreyes@nbfd.net PHONE: 949-644-3352 TITLE: Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) Payment ABSTRACT: On October 13, 2017, Governor Brown approved Senate Bill No. 523, related to Article 3.91 "Medi-Cal Emergency Medical Transportation Reimbursement Act" of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code. The primary purpose of the regulation was to impose a mandatory Quality Assurance Fee (QAF) on ground emergency medical transport (GEMT) providers, including public agencies like the City of Newport Beach (City). Payment for calendar year 2022 is now due. 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; and b) Approve Budget Amendment No. 23-062 appropriating $215,244.54 in increased expenditures in Account No. 01040404-821009 (GEMT QAF) from the General Fund unappropriated fund balance for mandatory payment of the 2022 Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF). DISCUSSION: The Medi-Cal program, administered by the State of California (State) through the Department of Health Care Services (DHCS), provides qualified low-income individuals in California with healthcare services. Emergency Medical Services (EMS) like those provided by the Newport Beach Fire Department fall under these services. The Medi-Cal program is partly governed and funded by Federal Medicaid provisions. DHCS, in accordance with SB 523, established a QAF program that would provide supplemental Medi-Cal payments to GEMT providers. SB 523 requires GEMT providers to provide the State data on the number of actual emergency medical transports by payer type and on gross receipts. RX Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) Payment March 28, 2023 Page 2 Using data collected from GEMT providers, DHCS calculates an annual GEMT QAF rate that is imposed on each emergency medical transport provided by GEMT providers subject to QAF. The collected funds are used to increase reimbursement to GEMT providers by applying an add -on amount to the fee -for -services (FFS) fee schedule rate for affected emergency medical transport billing codes. While SB 523 established reimbursements to providers with add -on payments for Medi-Cal services, the City has generally received a net loss in reimbursements due to the low number of Medi-Cal patients that are transported each year (approximately 10%.) Those service providers with a higher number of Medi-Cal patients experience a net positive financial result from the QAF program. In 2019, Assembly Bill (AB) 1705 established a federally approved Intergovernmental Transfer (IGT) program where local agencies provide funds to the State so the State can request matching funds from the federal government. This voluntary supplemental payment program will provide increased Medi-Cal reimbursements to publicly operated ambulance services. With the implementation of AB 1705 and a new IGT program in 2023, public providers will no longer be assessed the QAF. The City anticipates net revenue gains from this new IGT program. FISCAL IMPACT: Mandatory payment of $215,244.54 is now due, reflecting four quarterly payments for transport services in calendar year 2022. The Budget Amendment appropriates $215,244.54 in increased expenditure appropriations from the General Fund unappropriated fund balance to 01040404-821009 (GEMT QAF). This will be the final QAF payment to the State if the AB 1705 program is fully implemented. Add -on QAF funds received by the City from DHCS in 2022 approximate $207,460.00, resulting in a net loss of $7,784.54. 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. 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). ATTACHMENTS: Attachment A — Department of Health Care Services 2022 Quarterly Invoices Attachment B — Budget Amendment No. 23-062 FIN ATTACHMENT A DHO State of California —Health and Human Services Agency .eK, W1,111111 Department of Health Care Services MICHELLE BAASS GAVIN NEWSOM DIRECTOR GOVERNOR Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) — Quarterly Payment Provider Invoice Name: CITY OF NEWPORT BEACH DHCS Account Number: GEM1679579296 - o . - 2/1 /2023 Year: 2022 QTR: Q1 Invoice Number: GEM02232100 Amount Due: $ 52,390.80 Emergency• • e- Quantity: Medi-Cal Fee -for -Service 20 Medi-Cal Managed Care 132 Medicare 744 Other 583 Dual Medicare/Medi-Cal 61 Amount Due = Sum of Total Transports x QAF Rate ($34.02 ) _ $ 52,390.80 1. Please use the invoice number provided above to pay via Electronic Funds Transfer (http://dhcs.ca.gov/epay). M40 2. Please submit this invoice and payment to: ATTN: GEMT QAF Accounting Section/Cashiers Unit, Mail Stop 1101 1501 Capitol Avenue P.O. Box 997415 Sacramento, CA 95899-7415 Third Party Liability and Recovery Division, General Collection Section, MS 4720 P.O. Box 997425, Sacramento, CA 95899-7425 EE State of California —Health and Human Services Agency IDHCS G Department of Health Care Services 1q01 O MICHELLE BAASS GAVIN NEWSOM DIRECTOR GOVERNOR Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) — Quarterly Payment Provider Invoice Name: CITY OF NEWPORT BEACH DHCS Account Number: GEM1679579296 ® • ®. 0 3/1 /2023 Year: 2022 QTR: Q2 Invoice Number: GEM0323579G Amount Due: $ 56,677.32 Emergency•eType-. Medi-Cal Fee -for -Service Quantity- 16 Medi-Cal Managed Care 159 Medicare 771 Other 661 Dual Medicare/Medi-Cal 59 Amount Due = Sum of Total Transports x QAF Rate ($34.02 ) $ 56,677.32 1. Please use the invoice number provided above to pay via Electronic Funds Transfer (http://dhcs.ca.gov/epay). C61 V 2. Please submit this invoice and payment to: ATTN: GEMT QAF Accounting Section/Cashiers Unit, Mail Stop 1101 1501 Capitol Avenue P.O. Box 997415 Sacramento, CA 95899-7415 Third Party Liability and Recovery Division, General Collection Section, MS 4720 P.O. Box 997425, Sacramento, CA 95899-7425 DHCS State of California —Health and Human Services Agency Department of Health Care Services - MICHELLE BAASS GAVIN NEWSOM DIRECTOR GOVERNOR Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) — Quarterly Payment Provider Invoice Name: CITY OF NEWPORT BEACH DHCS Account Number: GEM 1679579296 Due Date: 4/1/2023 Year: 2022 QTR: Q3 Invoice Number: GEM042330EF Amount Due: $ 58,140.18 __..........._._.............._.............._........._..............._..........._._._.........._._.........._..........._....-.........-............._._._......._...._............_._._........_._._............_.............._._............ _............._ ..._._._.............-........,._._......._._........................... _._._........._._ Fiscal Year Reporting Structure Account App Ref Service Location 2021... 2.2 .... _. ....... 4260KBOB................ ..........41.29200....._._................_._._........_._._...._98.0.._._._..........._._............... --- ...............Act vitY........_._...................._....._......._._.._Pro.gra.m.............._._..........._ Alt Account Fund Project ....._._..........._......._..........._..........._............_........_...._.............._........._9990............................................................... _.....-3323.............. .................. ..._._........... Emergencye•Type: Quantity: Medi-Cal Fee -for -Service 22 Medi-Cal Managed Care 173 Medicare 824 Other 632 Dual Medicare/Medi-Cal 58 Amount Due = Sum of Total Transports x QAF Rate ($34.02 ) _ $ 58,140.18 Payment Instructions: 1. Please use the invoice number provided above to pay via Electronic Funds Transfer (http://dhcs-.ca.gov/epav). OR 2. Please submit this invoice and payment to: ATTN: GEMT QAF Accounting Section/Cashiers Unit, Mail Stop 1101 1501 Capitol Avenue P.O. Box 997415 Sacramento, CA 95899-7415 Third Party Liability and Recovery Division, General Collection Section, MS 4720 P.O. Box 997425, Sacramento, CA 95899-7425 AW DHCS State of California —Health and Human Services Agency. Department of Health Care Services ` g w MICHELLE BAASS GAVIN NEWSOM DIRECTOR GOVERNOR Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) — Quarterly Payment Provider Invoice Name: CITY OF NEWPORT BEACH DHCS Account Number: GEM1679579296 - 11115. - 5/1 /2023 Year: 2022 QTR: Q4 Invoice Number: GEM05233ED8 Amount Due: $ 48,036.24 Emergency.. .- Medi-Cal Fee -for -Service Quantity: 20 Medi-Cal Managed Care 122 Medicare 663 Other 569 Dual Medicare/Medi-Cal 38 Amount Due = Sum of Total Transports x QAF Rate ($34.02 ) _ $ 48,036.24 1. Please use the invoice number provided above to pay via Electronic Funds Transfer (http://dhcs.ca.gov/epay). 2. Please submit this invoice and payment to: ATTN: GEMT QAF Accounting Section/Cashiers Unit, Mail Stop 1101 1501 Capitol Avenue P.O. Box 997415 Sacramento, CA 95899-7415 Third Party Liability and Recovery Division, General Collection Section, MS 4720 P.O. Box 997425, Sacramento, CA 95899-7425 :. aE`�P°Rr City of Newport Beach ATTACHMENT B BUDGET AMENDMENT 2022-23 BA#: 23-062 Department: Fire ONETIME: ❑ Yes ❑ No Requestor: Raymund Reyes Approvals ❑ CITY MANAGER'S APPROVAL ONLY Finance Director: AIA+ aMOVK Date 3117�23 El COUNCIL APPROVAL REQUIRED City Clerk: Date EXPLANATION FOR REQUEST: Ground Emergency Medical Transport (GEMT) Qualitity Assurance Fee (QAF) Payment ❑ from existing budget appropriations ❑ from additional estimated revenues 0 from unappropriated fund balance REVENUES Fund # Org Object Project Description Increase or (Decrease) $ Subtotal �$ EXPENDITURES Fund # Org Object Project Description Increase or (Decrease) $ 010 01040404 821009 EMERGENCY MEDICAL SERVICES - GEMT OAF 215,244.54 Subtotal) $ 215,244.54 FUND BALANCE Fund # Object Description Increase or (Decrease) $ 010 300000 GENERAL FUND - FUND BALANCE CONTROL (215,244.54) Subtotal! $ (215,244.54) Fund Balance Change Required 8-7