HomeMy WebLinkAbout23568AGREEMENT INFORMATION
AGREEMENT NUMBER
23568
NAME/TYPE OF AGREEMENT
UNITED HEALTHCARE
DESCRIPTION
LETTER OF AGREEMENT/MEDICAID SUPPLEMENTAL
PAYMENTS FOR EMERGENCY TRANSPORTATION
SERVICES/FILE ID: 6444/R-19-0512/MATTER ID: 21-500
EFFECTIVE DATE
February 10, 2021
ATTESTED BY
TODD B. HANNON
ATTESTED DATE
3/3/2021
DATE RECEIVED FROM ISSUING
DEPT.
8/20/2021
NOTE
CITY OF MIAMI
DOCUMENT ROUTING FORM 5cig
ORIGINATING DEPARTMENT: Fire -Rescue
DEPT. CONTACT PERSON: Maria T. Martinez EXT. 1672
NAME OF OTHER CONTRACTUAL PARTY/ENTITY: "United Healthcare"
IS THIS AGREEMENT A RESULT OF A COMPETITIVE PROCUREMENT PROCESS? E YES X NO
TOTAL CONTRACT AMOUNT: $ FUNDING INVOLVED? ❑ YES X NO
TYPE OF AGREEMENT:
❑ MANAGEMENT AGREEMENT
PROFESSIONAL SERVICES AGREEMENT
GRANT AGREEMENT
❑ EXPERT CONSULTANT AGREEMENT
❑ LICENSE AGREEMENT
❑ PUBLIC WORKS AGREEMENT
❑ MAINTENANCE AGREEMENT
❑ INTER -LOCAL AGREEMENT
❑ LEASE AGREEMENT
❑ PURCHASE OR SALE AGREEMENT
OTHER: (PLEASE SPECIFY) Letter of Agreement between the City of Miami Department of Fire -
Rescue and United Healthcare.
PURPOSE OF ITEM (BRIEF SUMMARY): The City on behalf of the Dept. as a Government Owned Emergency
Medical Services ("EMS") Provider has entered into LOA regarding Medicaid supplemental payments for emergency
transportation services.
COMMISSION APPROVAL DATE: 12/12/19 FILE ID: 7734 ENACTMENT NO.: R-19-0512
IF THIS DOES NOT REQUIRE COMMISSION APPROVAL, PLEASE EXPLAIN:
ROUTING INFORMATION :' °
Date
PLEASE PRINT AND SIGN
APPROVAL BY DEPARTMENTAL DIRECTOR
3/01/21
PRINT: Ty McGann, AFC
yy�
SIGNATURE: —� (—
SUBMITTED TO RISK MANAGEMENT
3/1/21
PRINT: ANN — MARK RPE
SIGNATURE: /
SUBMITTED TO CITY ATTORNEY
(21-500 - GKW)
PRINT: VICTORIA MENDEZ
SIGNATURE: /s George K. Wysong, III
APPROVAL BY ASSISTANT CITY MANAGER
PRINT:
SIGNATURE:
RECEIVED BY CITY MANAGER
PRINT- ORIEGA
IGN
1) ONE.ORIGINAL—TO CITY CLERK,
SIGNATURE:
PRINT:
SIGNATURE:
PRINT'
SIGNATURE:
2) ONE COPY TO CITY ATTORNEY'S OFFICE?
3) REMAINING ORIGINAL(S) TQORIGINATING
DEPARTMENT
PLEASE ATTACH THIS ROUTING FORM TO ALL DOCUMENTS THAT REQUIRE
EXECUTION BY THE CITY MANAGER
City of Miami
Office of the City Attorney
Legal Services Request
To: Office of'the City Attorney Date: 3/1/2021
From: Maria T. Martinez
Contact Person
Administrative Assistant I
Title
Fire -Rescue
Requesting Client
305-416-1672
Telephone
Legal Service Requested:
Please Review & Sign: "Letter of Agreement between the City Department of Fire -Rescue
and Florida Healthcare."
Please review and sign the aforementioned.
For Legal Services requesting an opinion from the Office of the City Attorney:
X Issue opinion in writing.
El Publish opinion after issuance.
Authorized by:
Date response requested by:
BELOW PORTION TO BE COMPLETED BY THE OFFICE OF THE CITY ATTORNEY
Assigned Attorney: Date: File No.
Approved by: Ultimate Client:
Comments: D / R Date:
Type:
Matrix:
Category:
Copy returned to Requesting Client
Copy to Ultimate Client
rev. 04/14/2017
LETTER OF AGREEMENT
This Letter of Agreement ("LOA") is made and entered into on the loth day of
February , 2021 by and between the City of Miami, a municipal corporation of the State of
Florida ("City"), whose principal address is 3500 Pan American Drive, Miami, Florida 33133, on
behalf of its Depaitiuent of Fire -Rescue ("Department" and "Government Owned Emergency
Medical Service (EMS) Provider") and United Healthcare ,duly organized
under the laws of the State of Florida, whose principal address is 495 N Keller Road, Florida as
a Medicaid Managed Care Organization ("Medicaid MCO") (herein referred to individually as
"Party" and collectively as "Parties").
WHEREAS, the Medicaid MCO has been awarded a contract ("AHCA Contract") by the
Agency for Health Care Administration ("AHCA") to deliver managed care services to Medicaid
enrollees under an 1115 Managed Medical Assistance Waiver (the "Waiver") in Region 11,
which includes Miami -Dade and Monroe Counties where Government Owned EMS Provider is
located and/or operates; and
WHEREAS, pursuant to City Commission Resolution No. 19-0512, adopted December
12, 2019 ("Authorizing Resolution"), the City on behalf of the Department as a Government
Owned Emergency Medical (EMS) Provider has entered into a Letter of Agreement, dated
December 31, 2019, including all extensions and renewals thereof, with ACHA ("City LOA"),
regarding Medicaid supplemental payments for emergency transportation services to Medicaid
beneficiaries within the Government Owned EMS Provider's areas of operation, which
Authorizing Resolution authorizes the City Manager to negotiate and execute this related LOA,
in a form acceptable to the City Attorney; and
WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying
entity and provides out of network emergency medical services to Medicaid MCO enrollees in
Region 11 on an as needed basis, when the transport and treatment are appropriate; and
WHEREAS, the Centers for Medicare and Medicaid Services ("CMS") approved Title 42
Code of Federal Regulations Section 438.6 ("Section 438.6") directed payments based on the
establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers
Page 1 of 4
for the provision of emergency medical services to Medicaid eligible persons enrolled in
managed care organizations pursuant to the Waiver, which includes the Medicaid MCO.
NOW THEREFORE, Government Owned EMS Provider and the Medicaid MCO do
hereby agree to the following:
1. Government Owned EMS Provider agrees to make emergency medical services available
to MCO's Medicaid enrollees on an as needed basis, when the transport and treatment are
appropriate.
2. Medicaid MCO shall receive per member per month Section 438.6 directed payments for
care and treatment provided by the Government Owned EMS Provider, which the
Medicaid MCO shall timely remit to the Government Owned EMS Provider in
accordance with AHCA's contractual requirements, including public records compliance,
record keeping, reporting, auditing, payment monitoring requirements, notices, and
limitations on assignments to subcontractors under the AHCA Contract and the City
LOA.
3. Contact information for the Parties is as follows:
Government Owned EMS Provider:
Robert M. Jorge MPA
Assistant Fire Chief
Health & Emergency Medical Services Division
City of Miami Dept. of Fire -Rescue
1151 NW 7 Street, Miami, FL 33136
305-416-5404 (Ph.)
786-351-3591 (Cell)
305-416-5444 (Fax)
Email: rjorge@miamigov.com
Page 2 of 4
Medicaid MCO:
William J. Warthen
Network Programs Manager
C & S Full Risk Capitation Relationships
United Health Networks
407.659.6917 (Ph.)
855.495.8078 (Secured Fax)
william Lwarthen@uhc.com
4. The Parties agree any modification to this LOA shall be in the same form, namely the
exchange of signed copies of a revised LOA.
5. This LOA covers the period of October 1, 2019, through June 30, 2024, unless terminated
sooner by the termination of Section 438.6 directed payments.
6. This LOA may be executed in several counterparts, all or any of which shall be regarded
for all purposes as one original and shall constitute and be but one and the same
instrument. An executed facsimile or electronic scanned copy of this LOA shall have the
same force and effect as an original. The Parties shall be entitled to sign and transmit an
electronic signature on this LOA (whether by facsimile, PDF, or other email
transmission), which signature shall be binding on the party whose name is contained
therein. Any party providing an electronic signature agrees to promptly execute and
deliver to the other party an original signed LOA upon written request.
IN WITNESS WHEREOF, the Parties have duly executed this LOA on the day and year
above first written. Each party represents that: (i) it has the authority to enter into this
Agreement; and (ii) that the individual(s) signing this Agreement on its behalf is/are authorized
to do so.
MEDICAID MANAGED CARE ORGANIZATION:
United Healthcare
By: Felix Gonzalez Vice President Government Programs
Name & Title of Authorized Individual
Page 3 of 4
Si a're of A on zed Individual
Date: 02/25/2021
Attest:
Name:
Date:
Title
GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER:
CITY OF MIAMI, a municipal corporation of the State of Florida
By:
Arthur`Noriega V, City Manager
Date:
Attest:
Date:
Approved as to Insurance Requirements:
By: 1
Ann -Marie Sharpe, Director
Department of Risk Management
Approved as to Legal Form and Correctness:
By: ?a-ti1aa6 L . ./6/6.
VictoriaMendez, City Attorney
(21-500 - GKW)
Page 4 of 4
AGENDA ITEM SUMMARY FORM
File ID: #6444
Date: 11/26/2019
Commission Meeting Date: 12/12/2019
Requesting Department: Office of
Management and Budget
Sponsored By:
District Impacted: All
Type: Resolution
Subject: MOU - Intergovernmental Transfer of Funds
Purpose of Item:
A resolution of the Miami City Commission, with attachment(s), authorizing the City of
Miami ("City") to participate in and receive reimbursements under the new Medicaid
Public Emergency Medical Transportation ("PEMT") and Managed Care Emergency
Medical System ("EMS") Supplement Payment Program ("Partial Reimbursement
Program") for Medicaid Managed Care ("MMC") patients transported by the City's
Department of Fire -Rescue ("Department"), with administration of federal funds by the
State of Florida ("State") through its Agency for Health Care Administration ("AHCA") for
the first program year ending June 30, 2020 ("First Program Year"); authorizing the City
Manager to negotiate and execute any and all necessary agreements, in a form
acceptable to the City Attorney.
Background of Item:
The Department of Fire -Rescue (Department) transports two types of patients covered
by Medicaid. Those that are enrolled in a Fee for Service (FFS) plans and those in
enrolled in Medicaid Managed Care plans (MMC). Currently, the Department receives
$190 for Advanced Life Support and $136 for Basic Life Support transports for both FFS
and MMC patients. These payments are comprised of both a State of Florida share of
38.53 percent and a federal government share of 61.47 percent.
Currently, the Department receives supplemental reimbursement for FFS transports
from the Federal government through the Public Emergency Medical Transport (PEMT)
Medicaid FFS program. In FY 2018-19 this program reimbursed an additional $2.343
million in revenues to the City of Miami. Therefore, paying a supplement in addition to
the State share payment for the transport of FFS patients.
In 2019, the Governor of the State of Florida (State) signed State Bill 2500 that
established the PEMT MMC program to provide a reimbursement supplement to public
transport providers for MMC patients. For MMC patients, federal rules 42 CFR 438.6
requires Florida to send its share of 38.53 percent of transport cost to the federal
government by mean of an intergovernmental transfer (IGT). The IGT certifies the that
public expenditures have been incurred. IGTs have been used from the beginning of
the Medicaid program.
The State established a funding pool of $54.000 million and requires that public
emergency medical transportation provider send their state share portion of 38.53
percent as an intergovernmental transfer to State of Florida Agency for Health Care
Administration (AHCA). AHCA will then leverage the State share portion in order to
receive the 61.47 percent federal portion from the Centers for Medicaid and Medicaid
Services (CMS) . CMS will then transfer back both the State and Federal share
portions to AHCA. ACHA will then disburse funds to the various Managed Care
Organizations (MCO) that currently reimburse the Department for transports. The
MCOs will then reimburse the City based on the number of transports formula. This
new program will pay a supplement above the fees that the City already is receiving.
For the City to participate in the PEMT MMC program, ACHA requires each transport
provider to sign a Letter of Agreement (LOA). This item is requesting the City Manager
to be given the authority to sign a Letter of Agreement with AHCA and to allocate
approximately $899,407 to be transferred to AHCA via and IGT.
Budget Impact Analysis
Item is Related to Revenue
Item is an Expenditure
Item is NOT funded by Bonds
Total Fiscal Impact:
The City expects to net $1.435 million in Federal share funds due to this new program. This
includes $899,407 from Fire -Rescue's General Fund budget that will be sent to Agency for
Health Care Administration and approximately $2.334 million of gross revenues received from
both the Federal and State of Florida governments.
General Account No: 00001.181000.881000.0000.00000
Office of Management and Budget
City Manager's Office
Legislative Division
City Manager's Office
Office of the City Attorney
Office of the City Attomey
City Commission
Office of the Mayor
Office of the City Clerk
Office of the City Clerk
Reviewed B
Christopher M Rose
Sandra Bridgeman
Valentin J Alvarez
Nikolas Pascual
Bamaby L. Min
Victoria Mendez
Maricarmen Lopez
Mayor's Office
City Clerk's Office
City Clerk's Office
Department Head Review
Assistant City Manager Review
Legislative Division Review
City Manager Review
Deputy City Attorney Review
Approved Form and Correctness
Meeting
Unsigned by the Mayor
Signed and Attested by the City
Rendered
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Clerk Completed
Completed
12/02/2019 1:13 PM
12/02/2019 1:16 PM
12/02/2019 1:28 PM
12/02/2019 2:43 PM
12/02/2019 7:32 PM
12/02/2019 10:38 PM
12/12/2019 9:00 AM
12/23/2019 5:33 PM
12/23/2019 5:44 PM
12/23/2019 5:44 PM
City of Miami
Legislation
Resolution
Enactment Number: R-19-0512
City Hall
3500 Pan American Drive
Miami, FL 33133
www.miamigov.com
File Number: 6444 Final Action Date:12/12/2019
A RESOLUTION OF THE MIAMI CITY COMMISSION, WITH ATTACHMENT(S),
AUTHORIZING THE CITY OF MIAMI ("CITY") TO PARTICIPATE IN AND
RECEIVE REIMBURSEMENTS UNDER THE NEW MEDICAID PUBLIC
EMERGENCY MEDICAL TRANSPORTATION AND MANAGED CARE
EMERGENCY MEDICAL SYSTEM SUPPLEMENT PAYMENT PROGRAM
("PARTIAL REIMBURSEMENT PROGRAM") FOR MEDICAID MANAGED CARE
PATIENTS TRANSPORTED BY THE CITY'S DEPARTMENT OF FIRE -RESCUE
("DEPARTMENT") WITH ADMINISTRATION OF FEDERAL FUNDS BY THE
STATE OF FLORIDA ("STATE") THROUGH ITS AGENCY FOR HEALTH CARE
ADMINISTRATION ("AHCA") FOR THE FIRST PROGRAM YEAR ENDING
JUNE 30, 2020 ("FIRST PROGRAM YEAR"); AUTHORIZING THE CITY
MANAGER TO NEGOTIATE AND EXECUTE ANY AND ALL NECESSARY
AGREEMENTS, ALL IN A FORM ACCEPTABLE TO THE CITY ATTORNEY, IN
ORDER TO PARTICIPATE IN THE PARTIAL REIMBURSEMENT PROGRAM
FOR THE FIRST PROGRAM YEAR, TO PROVIDE THE REQUIRED FIRST
PROGRAM YEAR CITY MATCH BY INTERGOVERNMENTAL TRANSFER(S)
OF FUNDS TO ACHA, AND TO RECEIVE APPROXIMATELY 61.47 PERCENT
BACK FROM THE FEDERAL SHARE OF THE PARTIAL REIMBURSEMENT
PROGRAM AND 38.53 PERCENT BACK FROM ACHA UNDER THE STATE
SHARE OF THE PARTIAL REIMBURSEMENT PROGRAM; AUTHORIZING
AND APPROPRIATING FROM ACCOUNT NO. 00001.181000.881000 TO BE
TRANSFERRED TO ACHA IN AN AMOUNT NOT TO EXCEED EIGHT
HUNDRED NINETY-NINE THOUSAND FOUR HUNDRED SEVEN DOLLARS
AND FORTY EIGHT CENTS ($899,407.48) WHICH IS APPROXIMATELY 38.53
PERCENT OF THE FUNDING REQUIRED TO BE PAID AS THE CITY MATCH
BY JANUARY 2020, OR SUCH OTHER TIME AS DESIGNATED IN WRITING
BY AHCA, IN ORDER FOR THE CITY TO PARTICIPATE IN THE PARTIAL
REIMBURSEMENT PROGRAM FOR THE FIRST PROGRAM YEAR AND WILL
REQUIRE THAT THE DEPARTMENT'S OPERATING BUDGET BE
INCREASED IN THE FISCAL YEAR 2019-20 MID -YEAR BUDGET
AMENDMENT; REQUIRING THE CITY MANAGER AND THE DEPARTMENT,
BEGINNING OCTOBER 1, 2020, TO PROVIDE TO THE CITY COMMISSION
AN ANNUAL REPORT ON THE FIRST PROGRAM YEAR'S PARTICIPATION
AND PARTIAL REIMBURSEMENTS TO THE CITY; FURTHER AUTHORIZING
THE CITY MANAGER TO NEGOTIATE AND EXECUTE, IN A FORM
ACCEPTABLE TO THE CITY ATTORNEY, ALL AMENDMENTS, EXTENSIONS,
RENEWALS, AND MODIFICATIONS TO ANY AND ALL FIRST PROGRAM
YEAR AGREEMENTS FOR THE PARTIAL REIMBURSEMENT PROGRAM;
PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, pursuant to the General Appropriation Act — Laws of the State of Florida
2019-15 and Section 409.908, Florida Statutes, the State of Florida ("State"), through its Agency
for Health Care Administration ("ACHA"), has created a new Medicaid Public Emergency
Medical Transportation ("PEMT") and Managed Care Emergency Medical System ("EMS")
supplement payment program ("Partial Reimbursement Program") to administer Federal funds
for reimbursements to local service providers for Medicaid Managed Care patients who ("MMC")
are transported to the hospital by PEMT providers and has appropriated $54.787 million for this
Partial Reimbursement Program; and
WHEREAS, the City of Miami's ("City") Department of Fire -Rescue ("Department")
transported 9,330 MMC patients in Fiscal Year 2017-18 and received approximately $1.512
million for this service; and
WHEREAS, by participating in the new Partial Reimbursement Program for MMC
patients, the City and the Department can substantially increase revenues for MMC patient
transports; and
WHEREAS, under the new Partial Reimbursement Program, the City and the
Department as a provider of MMC patient transports must enter into certain Reimbursement
Program Agreement(s) by December 31, 2019 and must send the local matching portion for the
state share ("State Share") portion of Partial Reimbursement Program by January 2020, or such
other time as designated in writing by AHCA, for the first program year ("First Program Year")
ending June 30, 2020 by means of an intergovernmental transfer to AHCA in order to allow the
State to certify the public expenditure incurred by the Department and to become eligible to
receive the Federal share ("Federal Share") for partial reimbursement to the City and the
Department;
NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF
MIAMI, FLORIDA:
Section 1. The recitals and findings contained in the Preamble to this Resolution are
adopted by reference and incorporated as if fully set forth in this Section.
Section 2. The City is authorized' to participate in and to receive reimbursements under
the Partial Reimbursement Program for MMC patients transported by the Department with
administration of Federal funds by the State through ACHA for the First Program Year ending
June 30, 2020.
Section 3. The City Manager is hereby authorized' to negotiate and execute any and all
necessary agreements, all in a form acceptable to the City Attorney, in order to participate in the
Partial Reimbursement Program for the First Program Year, to provide the required First
Program Year City match by intergovernmental transfer(s) of funds to ACHA, and to receive
approximately 61.47 percent back from the Federal Share of the Partial Reimbursement
Program and 38.53 percent back from the State Share of the Partial Reimbursement Program.
Section 4. An amount not to exceed eight hundred ninety-nine thousand four hundred
seven dollars and forty eight cents ($899,407.48) is authorized' and appropriated from Account
No. 00001.181000.891000 to be transferred to ACHA which is approximately 38.53 percent of
the funding required to be paid as the City match by January 2020, or such other time as
designated in writing by AHCA, in order for the City to participate in the Partial Reimbursement
Program for the First Program Year.
Section 5. The City Manager and the Department, beginning October 1, 2020, are
required to provide to the City Commission an annual report on the First Program Year's
participation and partial reimbursements to the City.
Section 6. The City Manager is further authorized' to negotiate and execute, in a form
acceptable to the City Attorney, all amendments, extensions, renewals, and modifications to any
and all First Program Year Agreements for the Partial Reimbursement Program.
Section 7. This Resolution shall become effective immediately upon its adoption and
signature of the Mayor.2
APPROVED AS TO FORM AND CORRECTNESS:
ria
ttor ev 12/2/2019
1 The herein authorization is further subject to compliance with all requirements that may be imposed by
the City Attorney including but not limited to those prescribed by applicable City Charter and City Code
provisions.
2 If the Mayor does not sign this Resolution, it shall become effective at the end of ten (10) calendar days
from the date it was passed and adopted. If the Mayor vetoes this Resolution, it shall become effective
immediately upon override of the veto by the City Commission.
a US