HomeMy WebLinkAboutFD Agreement to Participate in Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer Program (PP-GEMT)____________________________________________________________________________________
FOR CITY CLERK ONLY
Council Meeting: June 5, 2023
Disposition: Resolution 15220
Agenda Item No: 5.k
Meeting Date: June 5, 2023
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Darin White, Fire Chief
Thomas Wong, Senior
Management Analyst
City Manager Approval: ______________
TOPIC: AGREEMENT TO PARTICIPATE IN PUBLIC PROVIDER GROUND EMERGENCY
MEDICAL TRANSPORTATION INTERGOVERNMENTAL TRANSFER PROGRAM
(PP-GEMT)
SUBJECT: RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE A
CERTIFICATION FORM FOR THE SAN RAFAEL FIRE DEPARTMENT TO
PARTICIPATE IN AN INTERGOVERNMENTAL TRANSFER (IGT) WITH THE
CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (DHCS) FOR
REIMBURSEMENT OF PUBLIC PROVIDER GROUND EMERGENCY MEDICAL
TRANSPORTATION (PP-GEMT) SERVICES FOR THE SERVICE PERIOD OF
JANUARY 1, 2023, THROUGH DECEMBER 31, 2023, AND TRANSFERS TO DHCS
NOT TO EXCEED $910,000
RECOMMENDATION:
Adopt a resolution authorizing the City Manager to execute a certification form for the San Rafael Fire
Department to participate in a Medi-Cal Intergovernmental Transfer (IGT) program with the California
Department of Health Care Services (DHCS) for reimbursement of PP-GEMT services for the service
period of January 1, 2023, through December 31, 2023, and make transfers not to exceed $910,000.
BACKGROUND:
In accordance with California Assembly Bill 1705 (Chapter 544, Statues of 2019), the Department of
Health Care Services developed the Public Provider Ground Emergency Medical Transportation
Intergovernmental Transfer Program (PP-GEMT) program to provide reimbursements, by application of
an add-on increase, to emergency medical transports provided by eligible public GEMT providers. This
program starts on January 1, 2023, and replaces the Ground Emergency Medical Transportation
Program (GEMT), which ended on December 31, 2022. The City previously participated in the GEMT
annually, since 2009.
Both the former GEMT and the newer PP-GEMT are programs to assist the City in recovering costs
associated with the provision of Emergency Medical Services (EMS) to individuals who are covered by
Medi-Cal. While PP-GEMT and the former GEMT share a name, the funding sources that support each
program are not the same. GEMT relied on State revenue, while PP-GEMT relies on Federal revenues.
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
This change in funding structure allows PP-GEMT to increase revenues, resulting in additional annual
funding for the City.
ANALYSIS:
Participation in the PP-GEMT program is mandatory for public provider agencies and provides an
important opportunity for the City to collect additional ambulance transport fees that would otherwise be
unavailable. Mandatory participation requires the City to collect and receive these additional ambulance
transport fees for each Medi-Cal transport the City provides.
While the PP-GEMT program is mandatory, cities, counties, and other public providers in the State may
optionally transfer funds to the State to support the program. This optional transfer, also referred to as
an Intergovernmental Transfer (IGT), allows the PP-GEMT program to secure Federal matching funds
that are the basis for providing additional add-on revenues for each Medi-Cal patient transported.
Without these matching funds from public providers, the State would not have adequate funds to
receive the Federal match. If the State does not receive adequate matching funds, the program would
cease to exist. While the IGT is optional, staff recommends the City provide the IGT to ensure ongoing
revenues associated with PP-GEMT continue.
DHCS has been working with the San Rafael Fire Department on estimating the benefits of the new
PP-GEMT since the fall of 2022. This estimating process has been challenging as DHCS cannot legally
mandate that government agencies participate in the IGT portion of the program. Since the IGT is
optional, the revenue that DHCS collects from providers to use as a federal match is solely dependent
on the number of agencies that choose to make the transfer. If there is a lack of participants, agencies
that do participate may be required to pay a higher rate, and the program may not have enough funding
to continue, jeopardizing this critical source of EMS funding.
Due to the uncertainty of the number of agencies opting to make optional IGTs, the California Fire
Chiefs Association (CFCA) has taken an active role in ensuring that all eligible agencies participate in
the IGT. Thus far, the outreach done at the State level has dramatically increased the number of
participants that have committed to providing the optional IGT. This increase in participation has
decreased the amount the City is currently estimated to owe versus earlier estimates. Currently, only a
handful of smaller agencies have yet to commit to providing their annual IGT, according to information
from CFCA. The broad support of public providers committing to making these transfers is in
recognition of the importance of the additional net benefit the program provides to agencies.
FISCAL IMPACT:
Yearly costs and benefits from the program to the City are dependent on the number of Medi-Cal
transports the City provides in a calendar year. Using last year’s Medi-Cal transport data, it is estimated
that the City’s 2023 IGT to the State will be $828,536. The City estimates that the revenues from the
PP-GEMT program will total $1,539,822 in increased Medi-Cal payments for each Medi-Cal transport
that the City provides. This includes additional new revenues of $711,285. The proposed funds to be
transferred to the State will be allocated from the Department’s Paramedic Tax Service Fund (210).
Time Period Funding
Source
Estimated
Transfer Amount
to DHCS
Estimated
Additional New
Funds
Estimated
Funds Returned
to City
2023 Calendar
Year Fund 210 $828,536 $711,285 $1,539,822
The PP-GEMT Certification Form lists an initial transfer of $200,433, which is the first of three transfers
this calendar year totaling an estimated $828,536. Staff recommends the Council authorize total
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3
transfers not to exceed $910,000 which would account for a 10% contingency in the event that fewer
agencies participate or the Fire Department transports additional Medi-Cal patients, both of which could
lead to higher transfers than expected.
OPTIONS:
1. Adopt the resolution as presented.
2. Direct staff to return with more information.
3. Take no action.
RECOMMENDED ACTION:
Adopt a resolution authorizing the City Manager to execute a certification form for the San Rafael Fire
Department to participate in a Medi-Cal Intergovernmental Transfer program with the California
Department of Health Care Services (DHCS) for reimbursement of PP-GEMT services for the service
period of January 1, 2023, through December 31, 2023, and make transfers not to exceed $910,000.
ATTACHMENTS:
1. Resolution
2. PP-GEMT Certification Form
1
RESOLUTION NO. 15220
RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE A CERTIFICATION FORM
FOR THE SAN RAFAEL FIRE DEPARTMENT TO PARTICIPATE IN AN
INTERGOVERNMENTAL TRANSFER (IGT) WITH THE CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES (DHCS) FOR REIMBURSEMENT OF PUBLIC PROVIDER
GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) SERVICES FOR THE
SERVICE PERIOD OF JANUARY 1, 2023, THROUGH DECEMBER 31, 2023, AND
TRANSFERS TO DHCS NOT TO EXCEED $910,000
WHEREAS, the City of San Rafael, through its Fire Department, regularly provides
emergency ambulance transport to persons who are Medi-Cal patients enrolled in managed care
and fee-for-service plans; and
WHEREAS, the City participates in various governmental programs that provide
reimbursement of costs incurred in providing such emergency services to Medi-Cal patients; and
WHEREAS, pursuant to California Assembly Bill 1705 (Chapter 544, Statues of 2019), the
Department of Health Care Services (DHCS) developed the Public Provider Ground Emergency
Medical Transportation (PP-GEMT) Intergovernmental Transfer Program to provide
reimbursements, by application of an add-on increase, to emergency medical transports provided
by eligible PP-GEMT providers; and
WHEREAS, by participating in the Intergovernmental Transfer Program, the City will
receive reimbursements for a larger proportion of its actual costs for providing emergency
ambulance transport to Medi-Cal patients enrolled in managed care and fee-for-service plans;
and
WHEREAS, under the Intergovernmental Transfer Program certification form, the funds
shall be transferred in accordance with a mutually agreed-upon schedule between the City of San
Rafael and DHCS.
NOW, THEREFORE, BE IT RESOLVED, by the San Rafael City Council as follows:
1. The San Rafael Fire Department is hereby authorized to participate in a voluntary
Intergovernmental Transfer (IGT) with the California Department of Health Care
Services (DHCS) for the service period of January 1, 2023 through December 31,
2023.
2. The City Manager is hereby authorized to execute the Intergovernmental Transfer
Certification Form, for the transfer of public funds to the DHCS, included in the staff
report for this resolution.
3. The City Council hereby authorizes the transfer of funds to DHCS, in an amount not
to exceed $910,000, approved by the City Manager and in accordance with a mutually
agreed upon schedule, to be used solely as a portion of the non-federal share of funds
that qualify for federal financial participation for the period of January 1, 2023 through
December 31, 2023.
2
I, LINDSAY LARA, Clerk of the City of San Rafael, hereby certify that the foregoing
Resolution was duly and regularly introduced and adopted at a regular meeting of the City Council
of said City held on Monday, the 5th day of June, 2023, by the following vote, to wit:
AYES: Councilmembers: Bushey, Hill, Kertz, Llorens Gulati & Mayor Kate
NOES: Councilmembers: None
ABSENT: Councilmembers: None
Lindsay Lara, City Clerk
DEPARTMENT OF HEALTH CARE SERVICES
PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR
GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
CERTIFICATION FORM FOR STATE CALENDAR YEAR 2023
I, the undersigned, hereby declare and certify on behalf of ______________________
(the “Public Entity”) as follows:
1. As a public administrator, a public officer, or other public individual, I am duly au-
thorized to make this certification.
2. The Public Entity elects to make this intergovernmental transfer (IGT) to the De-
partment 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 Wel-
fare 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 Med-
icaid payments, federal money excluded from use as the non-federal share, im-
permissible health care-related taxes, or non-bona fide provider-related donations.
3. Voluntary contributions attributable to the period of January 1, 2023, through De-
cember 31, 2023, 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 supple-
mental 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, subdivision (h)(1)
(hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Trans-
portation (GEMT) Intergovernmental Transfer (IGT) Program, or the PP-GEMT
IGT Program), and DHCS costs associated with administering the PP-GEMT IGT
Program.
4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP
for the PP-GEMT IGT Program as permitted by federal law. In the event DHCS is
unable to obtain FFP for the PP-GEMT IGT 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.
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 per-
cent (10%) fee on each transfer of public funds to the state to pay for health care
DEPARTMENT OF HEALTH CARE SERVICES
PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR
GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
CERTIFICATION FORM FOR STATE CALENDAR YEAR 2023
coverage and to reimburse DHCS its costs associated with administering the PP-
GEMT IGT 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 Public Entity acknowledges that all records of funds transferred are subject
to review and audit upon DHCS’ request. The Public Entity will maintain docu-
mentation supporting the allowable funding source of the IGTs.
8. 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 fore-
going 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.
Executed on this ______ day of _________, 20XX at __________________, California.
Signature of Authorized Person: __________________________________________
Name of Authorized Person: _____________________________________________
Title of Authorized Person: ______________________________________________
Name of Public Entity: _______________________________________________
NPI of Public Entity: _______________________________________________
Amount of IGT: $200,433.00
# # #
