Legislative Action Center

FFCA wins approval of supplemental reimbursement for ambulance transport
October 24, 2016 by Darrel Donatto
Cities, counties, and special purpose districts within the State of Florida provide emergency medical service care to the citizens and visitors of their communities.  In fact, over 80% of the people within the State of Florida receive their emergency medical service care from a fire rescue provider of a city, county, or special purpose district and a large portion of the remaining population receive their care from a county run emergency medical service provider.

Many cities, counties, and special purpose districts attempt to recoup a portion of the costs for providing emergency medical service care to their medically indigent adult (MIA) population by billing a fee for service.  The amount received through fee for service billing is generally very small in comparison to the costs to provide this service.  Fee for service billing is limited to those medically indigent patients who are transported to the hospital by ambulance and does not include the ability to bill for services provided where the patient is not transported to the hospital.

Title 42, Chapter IV, Subchapter C, Part 433, Subpart B, Section 433.50 and 433.51 of the Federal Code of Regulations provides that a state, a city, a county, a special purpose district, or other governmental unit in a state may secure a federal match for care to their medically indigent adult (MIA) population (those adults with incomes less than 133% of the federal). This federal match is uncapped.

This means that cities, counties, and special purpose districts may obtain reimbursement for up to 60% of the unreimbursed costs they expend to provide emergency medical service care to their medically indigent population. This can be done through a “Certified Public Expenditure” (CPE) program.

CPEs are one of several mechanisms that a state may employ to obtain federal financial participation for medical services provided to their indigent population.  CPEs are the required match under the federal regulations.  Under a CPE arrangement, government providers certify their Medicaid expenditures to the state, and the state then obtains additional federal reimbursement on the basis of these CPEs at a rate of 60%. CPEs can come from a county, city, special purpose district, Indian tribe or other governmental unit that has taxing authority and direct access to revenues.  This also includes state university teaching hospitals with direct appropriations from the state.  The funds must be “certified,” meaning that the public contributing agency certifies them as expenditures eligible for federal financial participation (FFP).  Once the state receives this certification, the state can draw down the federal matching funds to reimburse the local provider.

Several States, including Texas, North Carolina, Indiana, and California have passed legislation allowing cities, counties, and special purpose districts to receive reimbursement for the emergency medical service care that they provide to their medically indigent population.  This supplemental reimbursement is for what these communities are already doing and does not require new services or services to a new group of people who are not being served.

The Florida Fire Chiefs' Association, through its Government Relations Committee and the lobbying firms of Johnson & Blanton and Prutsman & Associates championed the effort to bring this program to Florida.  In the 2015 legislative session, the FFCA was successful in getting this program passed by the Florida Legislature.  This program allows Florida cities, counties, and special purpose districts to receive supplemental reimbursement for the emergency medical service care that they provide to their medically indigent population without any cost to the state General Fund. In the 2016 legislative session, the program was renewed and an addition was made to allow for medicaid managed care patients to be covered under the reinbursement program.

The program required Federal government approval of an amended Medicaid “State Plan.” The state plan is the funding agreement between the state Medicaid agency and the federal government.  On October 20, 2016, the Florida received their State Plan amendment approval.

On October 28, 2016, a discusssion forum will take place at:
Miami-Dade Fire Rescue Training Center, 9300 NW 41 Street, Doral, Florida

The purposed of this forum is to discuss the cost reporting forms required by AHCA, share information about the methodology used to analyze relevant data, and possibly develop a common approach to that can be replicated by other agencies.

WEBINAR information will be sent to the email address used to register early next week.
If you have any questions call Miami-Dade Fire Rescue, Assistant Director Scott Mendelsberg at 786-331-5121
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