C7L -  

Resolutions - C7 L

C7 L A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE CITY’S FIRE DEPARTMENT TO PARTICIPATE IN INTERGOVERNMENTAL TRANSFERS (IGTs) WITH THE STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA), UNDER THE SUPPLEMENTAL PAYMENT PROGRAM FOR MEDICAID MANAGED CARE PATIENTS (THE “PROGRAM”), FOR THE STATE BUDGET PERIOD OF JULY 1, 2025 THROUGH JUNE 30, 2026 (THE SEVENTH PROGRAM YEAR); AND FURTHER AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE ANY REQUIRED AGREEMENTS OR DOCUMENTS RELATING TO THE CITY’S PARTICIPATION IN THE PROGRAM, SUBJECT TO REVIEW AND APPROVAL BY THE CITY ATTORNEY. Applicable Area:

COMMISSION MEMORANDUM

RECOMMENDATION

It is recommended that the Mayor and City Commission of the City of Miami Beach approve the attached resolution authorizing an Intergovemmental Transfer (IGT) program between the City of Miami Beach and the State of Florida (State) to provide a supplemental payment program for Medicaid Managed Care patients. The resolution also authorizes the City Manager to execute all required documents, including provider contracts and agreements with the Agency for Health Care Administration (AHCA), subject to ratification, to implement the supplemental payment program.

BACKGROUND/HISTORY

In 2018, the State of Florida authorized creation of a Certified Public Expenditure (CPE) program to provide supplemental payments to publicly owned and operated emergency medical transportation providers for Medicaid fee service patients transported to local hospitals. These funds are appropriated from the Medical Care Trust Fund for the Certified Public Expenditures Program for Emergency Transportation Services and supplement the managed Medicaid shortfall. The program helps providers recover their share of federal Medicaid reimbursement by allowing the State to certify the public expenditures incurred yearly by MBFD as the State share.

ANALYSIS

Miami Beach Fire Department transports approximately 7,000 patients annually to local hospital emergency rooms, generating approximately $2 million per year from Medicare, Medicaid, private commercial insurance companies and individual payers. A small percentage of the patients transported to the hospital each year are covered by Medicaid. The average reimbursement for the services per Medicaid patient is on average $115. This amount is significantly lower when compared to reimbursements of $275 and $501 from Medicare and patients with private health insurance, respectively. The State (CPE) program helps cover the gap between Medicaid

payments and the shortfall.

FISCAL IMPACT STATEMENT

Authorizing CMBFD to make an IGT payment to the state, in the amount not to exceed $228,351.22, representing 43% (City's portion) of the projected City's uncovered costs to transport patients (who are insured by a Medicaid managed care insurance plan) to the hospital (Medicaid managed care shortfall); and authorizing the city to accept the reimbursement of the city's portion from the state, plus payments from the participating Medicaid managed care insurance companies, in the collective amount of $533,780.31 (total net supplemental payments), representing 57% of the Medicaid managed care shortfall.

Does this Ordinance require a Business Impact Estimate? (FOR ORDINANCES ONLY)

If applicable, the Business Impact Estimate (BIE) was published on: See BIE at: https://www.miamibeachfl.gov/city-hall/city-clerk/meeting-notices/

FINANCIAL INFORMATION

Account(s)011-1220-Amount(s)$228,351.22, Services 000312-19-401-505-00-00-00-Professional

CONCLUSION

The Administration recommends the Mayor and City Commission approve this resolution.

Applicable Area

Citywide

Was this Agenda Item initially requested by a lobbyist which, as defined in Code Sec. 2-481, includes a principal engaged in lobbying? No

If so, specify the name of lobbyist(s) and principal(s):

Department

Fire

Sponsor(s)

Co-sponsor(s)

Condensed Title

Authorize Fire Dept to Participate in IGT with AHCA. FD

Previous Action (For City Clerk Use Only)

RESOLUTION NO.

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A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE CITY'S FIRE DEPARTMENT TO PARTICIPATE IN INTERGOVERNMENTAL TRANSFERS (IGTs) WITH THE STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION (AHCA), UNDER THE SUPPLEMENTAL PAYMENT PROGRAM FOR MEDICAID MANAGED CARE PATIENTS (THE "PROGRAM"), FOR THE STATE BUDGET PERIOD OF JULY 1, 2025 THROUGH JUNE 30, 2026 (THE SEVENTH PROGRAM YEAR); AND FURTHER AUTHORIZING THE CITY MANAGER AND CITY CLERK TO EXECUTE ANY REQUIRED AGREEMENTS OR DOCUMENTS RELATING TO THE CITY'S PARTICIPATION IN THE PROGRAM, SUBJECT TO REVIEW AND APPROVAL BY THE CITY ATTORNEY.

WHEREAS, the State of Florida has created a supplemental payment program for Medicaid managed care patients (the "Program") who are transported to the hospital by public emergency medical transportation providers and has appropriated an additional $260,000,000 for this program; and

WHEREAS, the City of Miami Beach Fire Department ("MBFD") transports approximately 400 Medicaid Managed Care Patients (as defined below) annually to hospitals and only receives approximately $115 per patient for this service; and

WHEREAS, by participating in the Program, the MBFD can substantially increase its Medicaid Managed Care Patient transport revenue and provide better services to the community; and

WHEREAS, the proposed operating budget for the MBFD includes an appropriation of $228,351.22 for intergovernmental transfers (IGTs) to support the Program and a corresponding $533,780.31 for Medicaid managed care transport revenue; and

WHEREAS, each year, based upon statistics from the prior year, the State of Florida Agency for Health Care Administration (AHCA) calculates how many patients who are covered by a Medicaid Health Maintenance Organization insurance plan ("Medicaid Managed Care Patients") are transported to hospitals by counties and municipalities (each, a "Governmental Entity"); and

WHEREAS, AHCA determines the total projected uncovered costs associated with these transportation services ("Medicaid Managed Care Shortfall"), and assigns each Governmental Entity its proportionate share of the transport services provided; and

WHEREAS, on October 30, 2024, the Mayor and City Commission adopted Resolution No. 2024-33309, approving the sixth year of the Program, funded by the State of Florida's budget for the period from July 1, 2024 through June 30, 2025; and

WHEREAS, AHCA will pay the Medicaid HMO insurance companies, who are the insurers for the Medicaid Managed Care Patients, their proportionate share of up to 57% of the approved federal funds; and

WHEREAS, each Governmental Entity is expected to front 43% of its proportionate share of the Medicaid Managed Care Shortfall, which will be refunded by AHCA, and each eligible

Government Entity will be paid, by the Medicaid HMO insurers, an amount of up to 57% of the estimated Medicaid Managed Care Shortfall; and

WHEREAS, the City's total allocation of Medicaid Managed Care Shortfall funds is $533,780.31; and

WHEREAS, the City will have to remit $228,351.22 to AHCA, representing the City's 43% share of the Medicaid Managed Care Shortfall ("City's Portion") for the seventh Program year; and

WHEREAS, under the Program, the City will receive a refund from AHCA for the City's Portion; and

WHEREAS, the City will also receive the supplemental funds, in an amount up to 57% of the projected Medicaid Managed Care Shortfall from the Medicaid HMO insurers of the Medicaid Managed Care Patients who received transportation services during the operative year, in the total sum of up to $305,429.09; and

WHEREAS, unlike the Certified Public Expenditure (CPE) program, which required no appropriation for the State share, these revenue and expense estimates are forward-looking to allow participation by the MBFD; and

WHEREAS, the Administration recommends authorizing the City Manager to execute all required agreements or documents relating to the City's participation in the Program for the seventh Program year.

NOW, THEREFORE BE IT DULY RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH FLORIDA, that the Mayor and City Commission hereby

authorize the City's Fire Department to participate in Intergovernmental Transfers (IGTs) with the State of Florida Agency for Health Care Administration (AHCA), under the supplemental payment program for Medicaid managed care patients (the "Program"), for the State budget period of July 1, 2025 through June 30, 2026 (the seventh Program year); and further authorize the City Manager and City Clerk to execute any required agreements or documents relating to the City's participation in the Program, subject to review and approval by the City Attorney.

PASSED and ADOPTED this

day of" 2025.

ATTEST:

Rafael E. Granado, City Clerk

Steven Meiner, Mayor

APPROVED AS TO FORM & LANGUAGE & FOH tCUTION

1o))2ou Date