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HomeMy WebLinkAboutBack-Up DocumentsFlorida Fire Chiefs' Association 221 Pinewood Drive • Tallahassee, FL 32303 • 850.900.5180 • www.ffca.org September 11, 2019 Robert Jorge, Assistant Chief Miami Fire Rescue Department 1151 NW 7 Street Miami, FL 33136 Re: Managed Care — EMS Supplement Payment Program Chief Jorge, First, I would like to thank you for attending our workshop session last month regarding the Medicaid Public Emergency Medical Transportation (PEMT) and Managed Care EMS Supplement Payment Program. I hope you found the session informative and encouraging. The Florida Fire Chiefs' Association (FFCA) has worked extremely hard these past three years on increasing the amount of federal monies available for reimbursement for our fire -based EMS providers in the state. Just as a little background, the FFCA has proactively established and developed crucial relationships with legislators, AHCA and service providers. Over the past year, we have expanded our scope of involvement by working with the Public Consulting Group to aid in the establishment and implementation of a Medicaid Managed Care Intergovernmental Transfer (IGT) program. The association recognizes the large amount of ongoing work entailed for both programs to be successful and continue to further reduce the Medicaid shortfall experienced by fire -based EMS providers. The FFCA, as part of our strategic initiatives and advocacy, supports the expansion of reimbursement for both the PEMT and IGT programs. We will continue to work to improve our involvement in the process to ensure that our fire -based EMS providers, and their communities, benefit. If you should have any other questions, please feel free to contact me. Sincerely, t,.rH,. 740..-1 Cak.�.. Wm. Ray Colburn, Fire Chief -Retired Executive Director Florida Fire Chiefs' Association Cc: Darrel Donatto, Fire Chief/FFCA President PROPRIETARY & CONFIDENTIAL CHANGE HEALTHCARE Introductions A Rick Iglesias - Change Healthcare • Revenue Cycle Manager, EMS Operations A Kevin Coyle - Revenue Optimization Solutions, LLC (Subcontractor) • PEMT Cost Report preparer/technical lead CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 2 Change Healthcare At -a -Glance CHANGE HEALTHCARE • One of the largest, independent healthcare technology companies • Customers across healthcare: providers, payers and consumers • Expansive software and analytics solutions • Broad imaging, workflow and extended care capabilities • Extensive network, data and connectivity • Increased scale for investment, innovation, and customer service • 15,000 team members CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 3 Change Healthcare's PEMT Clients A Currently working with 18 providers pursuing PEMT Revenues A Wide array or EMS agencies and Fire departments Change Healthcare Current Clients City of Miami Fire -Rescue Pinellas County Safety & Emergency Services Hialeah Fire Department Lauderhill Fire Rescue Flagler County Fire Rescue St. Lucie County Fire District Lee County EMS Stuart Fire Rescue Clay County Public Safety — Fire Rescue St. Lucie County Fire District Indian River County Fire Rescue Lehigh Acres Fire Control and Rescue District Miramar Fire Rescue Margate -Coconut Creek Fire Rescue Boca Raton Fire Rescue Apopka Fire Department Fernandina Beach Fire Department Brevard County Fire Rescue A This is the first year of the Medicaid Managed Care Supplemental Payment Program • Change Healthcare's role is to educate you about the program and assist if you decide to participate. CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 4 Overview of Medicaid Funding & Supplemental Payment Programs AThe State of Florida established a Medicaid Supplemental Payment Program to address Medicaid payment shortfalls through the regular billing process • Current State Medicaid payment rates for ambulance transports do not take into account the cost of providing the services ACurrent Medicaid payment rates of $190 per ALS-1 or $136 per BLS Emergency transport represents 10% or less of actual cost to provide that transport • City of Miami Fire -Rescue cost per transport = $2,600 CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL Overview of Medicaid Funding & Supplemental Payment Programs AThe State Medicaid Agency (Agency for Health Care Administration / AHCA) and the federal Centers for Medicare and Medicaid Services (CMS) established the Public Emergency Medical Transport (PEMT) Medicaid Fee For Service Program and the PEMT Cost Report in 2016 • Federal rules allow for CMS and States to establish alternative payment methodologies for certain classes of providers to address, in part, payment shortfalls / inadequacies • Code of Federal Regulations — 42 CFR Chapter IV, Parts 430-456; 475-481 ACity of Miami Fire -Rescue generates significant revenue through the submittal of the PEMT Cost Report • $2.3 million from the 2018 Cost Report • $27.9 million across all 65 participating providers • Supplemental payment is for Medicaid fee for service transports only CHANGE HEALTHCARE PROF'RII IARY & CONIRDF. NI IAI 7 Overview of Medicaid Funding & Supplemental Payment Programs AThe PEMT Cost Report / PEMT Fee For Service Program is a good start AHowever, Medicaid in Florida has two components • Medicaid fee for service — supplemental payment through PEMT Cost Report • Medicaid managed care A The Florida Fire Chiefs Association (FFCA) reports that over 90% of all Medicaid transports in Florida for FY 2018 are managed care Program Medicaid FFS Medicaid Managed Care Totals Transports 25,957 276,213 302,170 % of Transports 8.6% 91.4% 100% CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL Overview of Medicaid Funding & Supplemental Payment Programs ACity of Miami Fire -Rescue shows similar Medicaid percentages • Medicaid fee for service — 1,498 transports (16%) • Medicaid managed care — 7,644 transports (84%) • Data is for FY 2018 • Trend in future is to have more patients moving to Medicaid managed care ASince Medicaid managed care is such a large portion of overall Medicaid transports, the FFCA championed a legislative effort to obtain approval and new funding to establish a Medicaid Managed Care Supplemental Payment Program. Approved in Senate Bill 2500, which was signed by the Governor DeSantis on 06/21/2019 CHANGE HEALTHCARE PROPRIE IARY & CONI-IDLNIIAL 9 Overview of Medicaid Funding & Supplemental Payment Programs A The Medicaid Managed Care Supplemental Payment Program or PEMT Managed Care Supplemental Payment Program addresses payment inadequacies related to Medicaid managed care transports • As with Medicaid fee for service, current Medicaid payment rates of $190 per ALS-1 or $136 per BLS emergency transport represent 10% or less of actual cost per transport • City of Miami Fire -Rescue cost per transport = $2,600 A The Medicaid Managed Care Supplemental Payment Program establishes a budget of $54 million in SB 2500; however, it also requires • State share funding through intergovernmental transfers (IGTs) from the provider community • Payments to be made to providers by Medicaid managed care organizations (MCOs) A Code of Federal Regulations — 42 CFR Chapter IV, Part 438 provides guidance • AHCA's "42 CFR 438.6(c), Proposal B 2019-2020" is proposal sent to CMS • Details that this is a supplemental payment via enhanced payment rates A City of Miami Fire -Rescue is not yet participating in this program CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 10 Overview of Medicaid Funding & Supplemental Payment Programs Comparison of Supplemental Payment Programs PEMT Fee For Service Managed Care 1. Requires Providers to submit a Medicaid 1. cost report on an annual basis. 2. Providers receive a Medicaid supplemental payment on difference of Medicaid cost compared to Medicaid payments received 2. from AHCA. 3. Medicaid supplemental payment is provider specific. 4. State share is provided through a certification of public expenditures (no transfer of funds). 5. Process repeats on an annual basis. 'Graphic from FFCA 3. 4. Medicaid managed care supplemental payments are made based upon transports, tied to utilization, and will be made on a quarterly basis or schedule approved by AHCJ1. Medicaid payments are not provider specific, as CMS requires consistent payments across provider classes. Medicaid payments are made by Medicaid managed care organizations (MCOs) and not by AHCA. Providers have to fund and transfer the state share through an intergovernmental Transfer (IGT) to AHCA. CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 11 Overview of Medicaid Managed Care Supplemental Payment Program ACity of Miami Fire -Rescue must decide to participate in the Medicaid Managed Care Supplemental Payment Program to receive supplemental payments for Medicaid managed care transports • Determine if the City of Miami is willing to transfer funds to the State — Intergovernmental transfer (IGT) • Determine if the City is willing to enter into an agreement with the State to transfer those funds - Letter of Agreement (LOA) • Determine if the City is willing to enter into an agreement with the individual Medicaid managec care organizations within Region 11— Managed Care Organization (MCO) Agreement A If the City of Miami Fire -Rescue does not participate, then they will continue to receive the $190/$136 through billings, but will not receive any supplemental payments for Medicaid managed care transports CHANGE HEALTHCARE PROPRILIARY &CONII R NIIAL 13 Overview of Medicaid Managed Care Supplemental Payment Program A Medicaid is a shared Federal and State insurance program • In Florida, when the City of Miami Fire -Rescue bills for a Medicaid transport (ALS-1) you receive $190.00 • The "federal share" of the $190 = 61.47%, or $116.79 and it comes from CMS • The "state share" of the $190 = 38.53%, or $73.21 comes from State of FL/AHCA A The State of Florida currently provides the state share to report to CMS, and once it is reported, CMS releases the federal share • Like a match • The State puts up 38.53%, then the feds (CMS) will provide their 61.47% • Providers receive 100% • Transfer $1 (38.53% state share); CMS provides $1.60 (61.47% federal share); $2.60 in total comes back A The state share can come from state or local governmental entities, as long as it is governmental funds CHANGE HEALTHCARE PROPRIETARY & CONFIDEN1IAL 14 Overview of Medicaid Managed Care Supplemental Payment Program AState budgets do not always allow for additional state funding to provide the state share • Can use local governmental funding to provide the state share instead A Florida Medicaid Managed Care Supplemental Payment Program has a total budget of $54,786,711 • 61.47% federal share = $33,677,391 • 38.53% state share/local = $21,109,320 • 65 governmental providers currently eligible to participate • SB 2500 requires that the local providers are responsible to provide the state share (38.53%/$21,109,320) through an IGT CHANGE HEALTHCARE PROPRIHARY & OONFIDENIIAL 15 Overview of Medicaid Managed Care Supplemental Payment Program A Participating providers will provide funding for the state share via a wire transfer or check to the state as an Intergovernmental transfer (IGT) • IGT to State of Florida on quarterly or semi-annual basis A State of Florida (AHCA) will use the IGT to receive federal share A State of Florida will distribute the state share and the federal share to Medicaid managed care organizations (MCOs) through establishment of a discrete "per member per month" payment methodology • AHCA will work with the State's Medicaid Actuarial Services office to determine PMPM • AHCA will send MCOs the funding to make supplemental payments to providers • Payment through MCOs because they act on behalf of the State to make payments per transport to all providers, and 438.6(c) stipulates that this is a supplement to those payment rates A Providers will be paid a lump sum supplemental payment on a quarterly/semi- annual basis that will be tied to utilization/number of Medicaid managed care transports *Graphic from FFCA Providers provide IGT State Share MCOs receive funding to pay enhanced payment Capitation rate is set based on projected MCO enrollment and utilization by MCO Providers are paid based on actual transports provicled CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 16 Overview of Medicaid Managed Care Supplemental Payment Program — Intergovernmental Transfer (IGT) A Intergovernmental transfer (IGT) is a transfer of funds from one government entity (e.g., city, county, etc.) to the state Medicaid agency (AHCA) • The IGT provides the state share necessary to guarantee federal matching funds for healthcare services for the country's low income population (quarterly/semi-annually) • IGTs will be used for the 38.53% A If providers do not provide the necessary IGT amounts, it may impact the success of the Medicaid Managed Care Supplemental Payment Program Healthcare Service Providers 'Graphic from FFCA Quarterly State share based on actual enrollment and uultzation reported by MCOs State and Federal share dollars are then disbursed through the MCO plans in lump suet payments back to providers AHCA draws down addtnottal Federal share dollars through IGT process CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 18 Overview of Medicaid Managed Care Supplemental Payment Program —Intergovernmental Transfer (IGT) A IGTs have been used by AHCA to fund the Florida hospital Low Income Pool (LIP) • Similar Medicaid supplemental payment program to Medicaid Managed Care Supplemental Payment Program A The amount of the IGT for the City of Miami is still undetermined • "No later" than October 31, 2019 A The IGT process will be initiated on a quarterly or semi-annual basis • AHCA will notify providers of IGT amounts and then the IGT will be sent to AHCA to draw federal funding • The participating providers' IGT amount (38.53%), along with the Federal funding (61.47%) will be passed through the MCOs back to participating providers Quarterly Timeline Example 44t44a[.]__12mtniper 71 Transports Provided 10 Managed Cale Enrollees "Graphic from FFCA riots/ Januan MCOs report number of transpo aid across quakfymg providers Mid Jenuery AHCA Invoices Providers for IGI Amount based on Transports Proved to MCO Enrolees rnd of January Providers Send IGT Amounts to AHCA Peoinrnno of February Al ICA makes capitation payments to Medicaid MCOs Mid 10 Late F Provider receives enhanced payments from MCOs CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 19 Overview of Medicaid Managed Care Supplemental Payment Program —Letter of Agreement (LOA) The Letter of Agreement (LOA) is an agreement between the provider and AHCA • Letting AHCA know that you are participating in the Medicaid Managed Care Supplemental Payment Program and that you are willing to participate in an IGT approach A IGTs must be considered a "bona fide donation" • Federal rule under 42 CFR § 433.54 • "Voluntary" A LOA must be signed and submitted to AHCA annually A LOA due to AHCA 4-6 weeks after the IGT amounts are established for each provider (October 31 at latest) A Very little flexibility in changing language of LOA CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 21 Overview of Medicaid Managed Care Supplemental Payment Program — Letter of Agreement (LOA) Public Emergency Medical Transpoitatton Letter of Agreement THIS LETTER OF AGREEMENT (LOA) is antic and entered n110 lo duphcale on the day of _2019, by and between IIGT PROVIDER) on behalf of (PROVIDER), and the Slate of Honda. Agency for Health Care Administration (the 'Agency-), for good and valuable consderatlon, the receipt and sufficiency of weigh is acknowledged DEFINITONS 'Intergovernmental Transters pets)' means tmn:ders of funds from a non-Medicad governmental entry (e g., cooties, rnx„opalties. hospital tannYg districts, ponders operated by Gate or locd gnvemment)to the Medicaid agency IGTsnud be considered a bona fide donation pursuant to 42 CFR§ 433 54. 'Medicaid' means the medical asostonce program authorized by Titre XIS of the Social Security Act, 42 US. G §§ 1390 et seq.. and regulations thereunder, as adnrrdslered in Florida by the Agency 'Public Emergency Medical Transportation (PEMT); pursuant la the General Appropnation Act. Laws of Florida 2019.115, is the program that provide', arpplenental payments for eligtthr Public, Emergency Medical Transportation (PENT) entitles that meet speared requkements and provide emergency medical transportation services to Medicaid beneficiaries. A. GENERAL PROVISIONS t. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2019-2020, passed by the 2019 Florida Legislature. the (IGT PROVIDER) and the Agency agree that the [IGT PROVIDER( will rents IGT funds to the Agency or an amount not to exceed the total of [IGT AMOUNT( The per PROVIDER] and the Agency have agreed that these IGT funds oil any be used for the PENT program 2. The [IGT PROVIDER) will return the signed LOA to the Agency no later than October 1. 2019 a The (IGT PROVIDER) wi( pay tGT funds to the Agency in en rmntml na to exceed the total of (IGTA MOUNT) The [IGT PROVIDER[ wan bander payments to the Agency In the following manner a. Per Florida Statute 409909, annual payments for the months of July 2019 thru June 2020 are due to the Agency no late( than October 31, 2019 unless an alternative plan is sped n:aliy approved by the agency b The Agency wag tilt the (IGT PROVIDER) when payment rs due IGT PROYIPER PRg0I1)FR PFMT 1.0A SFY 2019,20 CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 22 Overview of Medicaid Managed Care Supplemental Payment Program — MCO Agreement AThe Medicaid Managed Care Organization (MCO) Agreement is an annual agreement between the provider and each individual Medicaid MCO • It establishes the provider as eligible to receive supplemental payment • It establishes the expectation that the provider will be expecting a supplemental payment Medicaid MCOs will be contractually required to pay the enhanced funding from AHCA to qualifying providers • Qualifying providers are those that have a MCO Agreement in place A MCO Agreement will need to be in place before initial IGT is made CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 24 Overview of Medicaid Managed Care Supplemental Payment Program — MCO Agreement ACity of Miami Fire -Rescue is in Medicaid MCO Region 11 Region 1 Region 2 Region 3 Region 5 Region Region 1: Escambla Mebane, Santa Rosa. and' Ws tor Region 2: any, Calhoun Fienkin Gadsden, Gulf, Humes, Jackson. Jefferson, Lean, Liberty. Medinon. Taylor, Wan Jla, end Woenhgton Region 3: Alachua, 8radtril Canis. Columbia OINIe, GI:alaft Hert',IROn. Hernando. Lafayette Lake, Levi, Merlon. Putnam Sumter. Stn.nrnrtae, anc Union Region 4: Baker, Clay. Dime. Flaglar, Nassau St Johns, and Voluaa Region 5: Pasco and Pkaam Region 8: Hendee, Highlands, hilleborough Manatee and Potk Region 7: Biassed. Orange Osceola and Seminole Region 8: Charlotte, Collier, De Solo. Glades. Hendry Lae and Sa aaota Region 9: amen Po var. Martin. Okaachcbae. Pam Beam. and St. Lucia Region 10. E award Region 11 LI:arraOada and Monroe *Graphic from FFCA Revlon I Region 11 Region? CHANGE HEALTHCARE PROPRILIARY & CONI-IDLNIIAL 25 Overview of Medicaid Managed Care Supplemental Payment Program — MCO Agreement A 13 Medicaid MCOs in Region 11 • Agreements with each of the 13 MCOs (Humana Medical Plan, Aetna Better Health, Staywell, etc.) A The supplemental payment will be based on the PMPM payment from AHCA to the MCO Region AND the number of Medicaid managed care transports provided by the individual provider • The supplemental payment per transport will be the same within each Region, but it will vary across the MCO Regions. MCO1 MCO2 PM/PM Capitation Rate $1.58 $1.58 Medicaid Member Months for the Quarter 4,622,051 1,155,513 EMS Medicaid Managed Care Supplemental Payment Quarterly Pool $7,311,385 $1,827,846 Medicaid MCO Transports for Qualifying Providers 22,686 8,088 Medicaid MCO Enhanced Payment Per Transport $322.29 $225.99 `Graphic from FFCA CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 26 Overview of Medicaid Managed Care Supplemental Payment Program — MCO Agreement A Payments from the MCOs will be made 30-45 days after the IGT AAII funding received by the MCOs from AHCA will be required to be paid out to provider (net of any administrative fees approved by AHCA) Payments from MCOs will be based upon actual provider utilization/transports; therefore, AHCA is stating that "there will be no guarantee of funding compared to model projections" AAHCA will provide template language for MCO Agreement • End of October/early November timeline for language CHANGE HEALTHCARE PROPRIEIARY & CONFIDENTIAL 27 Frequently Asked Questions ACan you provide a summary of the Medicaid Managed Care Supplemental Payment Program mechanics? How the Program will Work • At the end of each quarter, MCOs will report total transports by provider to AHCA. Transports will be based upon paid transports for that quarterly period. • AHCA will determine funding to be distributed to each MCO based upon actual Medicaid enrollment. • AHCA will determine payment by provider for each MCO. • AHCA will request IGTs from provider community. • MCOs will receive funding from AHCA. • MCO payments will be made to providers. *Graphic from FFCA CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 29 Frequently Asked Questions ACan you provide the total amounts as they relate to the Medicaid Managed Care Supplemental Payment Program? • 65 providers participating will transfer/IGT $21,109,320 ■ IGT based on 2018 PEMT Cost Report expenses and/or Medicaid managed care transports ■ That is the 38.53% state share • Providers participating will receive total payments from MCOs of $54,786,711 ■ 38.53% state share/local = $21,109,320 ■ AND 61.47% federal share = $33,677,391 'Graphic from FFCA CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 30 Frequently Asked Questions A How much revenue is expected by participating in the Medicaid Managed Care Supplemental Payment Program? • It is difficult to predict • AHCA will need to publish the IGT amounts and MCO payment per transport amounts before preparing a sound estimate (October 31 at latest) • Some perspective can be gained by looking at the PEMT Cost Report/Fee For Service Program ■ Paid out $27.9 million in net federal supplemental payments in 2018 ■ The Medicaid Managed Care Supplemental Payment Program is budgeted for $33.7 million in net federal supplemental payments *Graphic from FFCA PROPRII I ARY & CONI DEN IIAL CHANGE HEALTHCARE 31 Frequently Asked Questions Are there any guarantees on how much revenue will be received? • No guarantee • The IGT calculation is separate from the MCO payment calculation ■ The IGT amount depends on expenses as reported in the PEMT Cost Report ■ The MCO payment amount is based on Medicaid managed care transports • However, the IGT is a "bona fide donation" • Before the IGT is made, make sure the "math" makes sense ■ IGT amount and MCO payment per transport amount by October 31 ■ 7,644 Medicaid managed care transports *Graphic from FFCA CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 32 Frequently Asked Questions AWhat about the example of transferring $1 and receiving $2.60 back, is that a guarantee? • No guarantee • We stated in previous slide: "Transfer $1 (38.53% state share); $2.60 comes back in total; net benefit of $1.60 (61.47% federal share)" ■ This may not hold for each MCO Region ■ This may not hold for each participating provider ■ Payments per MCO Region and subsequent payments per transport to the providers within a specific MCO Region are based on averages; therefore, the final payment to City of Miami Fire - Rescue may vary from the example *Graphic from FFCA CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 33 Contacts Rick Iglesias, Change Healthcare riciciglesias@changehealthcare.com 786-475-9706 Kevin Coyle, Revenue Optimization Solutions kcoyle@revopslIc.com 512-537-9588 CHANGE HEALTHCARE PROPRIETARY & CONFIDENTIAL 34 CH NGE CHANGE HEALTHCARE PROPRIEIARY & CONFIDENTIAL 35 Provider Total Allotment Total IGTs Needed Net New Federal Funding Alachua County Fire Rescue $ 1,422,752.01 $ 548,186.35 $ 874,565.66 Bay County EMS $ 718,874.47 $ 276,982.33 $ 441,892.14 Boynton Beach Fire Rescue $ 224,301.87 $ 86,423.51 $ 137,878.36 Brevard County Fire Rescue $ 1,529,686.62 $ 589,388.26 $ 940,298.37 Broward Sheriffs Fire Rescue $ 1,078,474.71 $ 415,536.31 $ 662,938.41 Charlotte County Fire & EMS $ 389,920.12 $ 150,236.22 $ 239,683.90 City of Hialeah Fire Department $ 401,982.87 $ 154,884.00 $ 247,098.87 City of Jacksonville - Fire Division Rescue Services $ 4,325,961.60 $ 1,666,793.00 $ 2,659,168.59 City of Key West Fire Department $ 52,815.27 $ 20,349.72 $ 32,465.54 City of Lauderhill Fire Rescue Department $ 448,277.73 $ 172,721.41 $ 275,556.32 City of Miami Fire -Rescue Department $ 2,334,304.40 $ 899,407.48 $ 1,434,896.91 City of Pembroke Pines Fire Rescue Department $ 264,728.38 $ 101,999.84 $ 162,728.53 City of Plantation $ 161,379.98 $ 62,179.71 $ 99,200.28 City of Sanford $ 279,073.26 $ 107,526.93 $ 171,546.33 City of St. Cloud Fire Rescue $ 113,129.00 $ 43,588.60 $ 69,540.40 City of Stuart Fire Rescue $ 67,486.17 $ 26,002.42 $ 41,483.75 City of Sunrise Fire Rescue $ 287,875.81 $ 110,918.55 $ 176,957.26 City of Tamarac Fire Department $ 120,627.46 $ 46,477.76 $ 74,149.70 Collier County EMS $ 620,090.36 $ 238,920.81 $ 381,169.54 Coral Springs Fire Department $ 246,797.27 $ 95,090.99 $ 151,706.28 County of Volusia $ 1,893,199.11 $ 729,449.62 $ 1,163,749.49 Flagler County Fire Rescue Department $ 139,210.61 $ 53,637.85 $ 85,572.76 Fort Lauderdale Fire Rescue $ 1,176,932.80 $ 453,472.21 $ 723,460.59 Fort Myers Beach Fire Department $ 25,429.57 $ 9,798.01 $ 15,631.56 Hallandale Beach Fire Rescue $ 164,966.20 $ 63,561.48 $ 101,404.73 Hamilton County EMS $ 117,693.28 $ 45,347.22 $ 72,346.06 Hernando County Fire Rescue $ 694,748.98 $ 267,686.78 $ 427,062.20 Highlands County EMS $ 376,553.29 $ 145,085.98 $ 231,467.31 Hillsborough County Fire Rescue $ 1,905,913.90 $ 734,348.62 $ 1,171,565.27 Hollywood Fire Rescue & Beach Safety Department $ 518,372.07 $ 199,728.76 $ 318,643.31 Indian River County ALS $ 379,813.49 $ 146,342.14 $ 233,471.36 Kissimmee Fire Department $ 438,823.14 $ 169,078.56 $ 269,744.59 Lake Emergency Medical Services $ 1,167,478.22 $ 449,829.36 $ 717,648.86 Lake Mary Fire Department $ 40,100.48 $ 15,450.72 $ 24,649.77 Lee County EMS $ 1,581,523.83 $ 609,361.13 $ 972,162.70 Lehigh Acres Fire Control and Rescue District $ 376,227.27 $ 144,960.37 $ 231,266.90 Leon County EMS $ 1,570,113.12 $ 604,964.59 $ 965,148.54 Maitland Fire Rescue Department $ 34,884.16 $ 13,440.87 $ 21,443.29 Manatee County EMS $ 839,827.95 $ 323,585.71 $ 516,242.24 Martin County Fire Rescue $ 252,013.59 $ 97,100.84 $ 154,912.75 Miami Beach Fire Department S 139,862.65 $ 53,889.08 $ 85,973.57 Miami -Dade Fire Rescue S 3,273,242.48 $ 1,261,180.33 $ 2,012,062.15 North Lauderdale Fire Rescue S 147,687.14 $ 56,903.85 $ 90,783.28 North Port Fire Rescue $ 123,887.66 $ 47,733.92 $ 76,153.75 Oakland Park Fire Rescue $ 238,972.78 $ 92,076.21 $ 146,896.57 Okaloosa County EMS $ 624,980.66 $ 240,805.05 $ 384,175.61 Okeechobee County Fire Rescue $ 186,809.56 $ 71,977.72 $ 114,831.83 Orange County Fire Rescue $ 3,124,577.28 $ 1,203,899.63 $ 1,920,677.65 Orlando Fire Department $ 939,264.10 $ 361,898.46 $ 577,365.64 Osceola County Fire Department $ 540,541.44 $ 208,270.62 $ 332,270.82 Palm Beach County Fire Rescue $ 1,835,819.56 $ 707,341.28 $ 1,128,478.28 Palm Beach Gardens Fire Rescue $ 106,608.59 $ 41,076.29 $ 65,532.30 Pasco County Board of County Commissioners - Fire Rescue $ 1,603,367.18 $ 617,777.37 $ 985,589.81 Pinellas County EMS Authority DBA Sunstar $ 4,617,749.65 $ 1,779,218.94 $ 2,838,530.71 Plant City Fire Rescue $ 127,473.89 $ 49,115.69 $ 78,358.20 Polk County Fire Rescue $ 2,878,432.05 $ 1,109,059.87 $ 1,769,372.18 Pompano Beach Fire Rescue $ 725,068.85 $ 279,369.03 $ 445,699.82 Riviera Beach Fire Department $ 320,151.80 $ 123,354.49 $ 196,797.31 Seminole County Fire Department $ 595,312.82 $ 229,374.03 $ 365,938.79 St. Lucie County Fire District $ 1,330,814.32 $ 512,762.76 $ 818,051.56 Tampa Fire Department $ 1,658,138.57 $ 638,880.79 $ 1,019,257.78 Temple Terrace Fire Department $ 85,743.30 $ 33,036.89 $ 52,706.41 Town of Davie Fire Rescue $ 218,433.51 $ 84,162.43 $ 134,271.08 West Palm Beach Fire Department S 491,312.39 $ 189,302.66 $ 302,009.73 Winter Park Fire -Rescue S 70,094.34 $ 27,007.35 $ 43,086.99 $ 54,786,711.00 $ 21,109,319.75 $ 33,677,391.25 1of1