C7V -  

Resolutions - C7 V

C7 V 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