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HomeMy WebLinkAboutCity of Tamarac Resolution R-2019-081 TR#13321 August 1, 2019 Page 1 CITY OF TAMARAC, FLORIDA RESOLUTION NO. R-2019 - / A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA APPROVING AMENDMENT 2 TO THE AGREEMENT WITH ADVANCED DATA PROCESSING, INC. (ADPI) A SUBSIDIARY OF R1 RCM INC. AND AUTHORIZING THE APPROPRIATE CITY OFFICIALS TO EXECUTE AMENDMENT 2 TO PROVIDE FOR THE ADMINISTRATION, PROCESSING AND COLLECTION OF ALL COSTS ASSOCIATED WITH TRANSPORT OF EMERGENCY MEDICAL SERVICES (EMS) PATIENTS MEDICAL BILLING AND RELATED PROFESSIONAL SERVICES ON BEHALF OF THE CITY OF TAMARAC FIRE RESCUE DEPARTMENT WITH AN EFFECTIVE DATE UPON EXECUTION OF THE AMENDMENT 2 THROUGH SEPTEMBER 30, 2021; PROVIDING FOR CONFLICTS; PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE. • WHEREAS, Tamarac Fire Rescue is required to provide basic and advanced life support services to the citizens and visitors of the City of Tamarac and to properly invoice and collect fees from the patients who utilize these services; and WHEREAS, the Agency for Healthcare Administration for the State of Florida received Federal Authority to amend Title XIX of the Social Security Act which provides funding for the Medicaid State Plan attached here to as Exhibit "1"; and WHEREAS, this program provides supplemental payments for an eligible Public Emergency Medical Transport (PEMT) entity that meets specified requirements and provides emergency medical transport service to Medicaid beneficiaries; and TR#13321 August 1, 2019 Page 2 WHEREAS, the City Commission of the City of Tamarac awarded an Agreement for Medical Billing Services to ADPI for a three (3) year term through September 30, 2019 via Resolution R-2016-83 at its August 24, 2016 City Commission Meeting; a copy of said resolution is on file with the City Clerk; and WHEREAS, ADPI has been acquired by R1 RCM, Inc., a leading provider of technology-enabled revenue cycle management (RCM) services to healthcare providers on May 8, 2018; and WHEREAS, the City Commission of the City of Tamarac approved Amendment 1 to the Agreement for Medical Billing Services to ADPI for a three (3) year term through September 30, 2019 via Resolution R-2016-121 at its October 26, 2016 City Commission Meeting; a copy of said resolution is on file with the City Clerk; and WHEREAS, ADPI has proposed Amendment "2" to the current ADPI billing 111 agreement for EMS billing and related professional services attached here to as Exhibit "2" to reduce the flat fee percentage from 15% to 12% of the net amount collected for Medicaid accounts providing for additional net revenue to the Fire Rescue Fund; and WHEREAS, the proposed Amendment "2" in addition to lowering the fees charged, is intended to extend the terms of the PEMT services to be co-terminus with the main agreement in Resolution R-2016-83, a copy of said resolution is on file with the City Clerk; and WHEREAS, the term of Amendment "2" is effective upon execution of agreement through September 30, 2021 which will coincide with the original term of the existing ADPI Billing Agreement and with the additional two (2) year renewal terms available for the Agreement with ADPI based on any potential re-negotiation and upon satisfactory performance and mutual agreement of both parties; and TR#13321 August 1, 2019 Page 3 WHEREAS, it is the recommendation of the Director of Financial Services, the Purchasing and Contracts Manager and the Fire Chief that the City Commission of the City of Tamarac approve Amendment "2" to be executed with ADPI. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA: SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and confirmed as being true and correct and are hereby made a specific part of this Resolution. The Exhibits attached hereto are incorporated herein and made a specific part hereof. SECTION 2: The appropriate City Officials are hereby authorized to execute Amendment"2"to the Agreement with Advanced Data Processing, Inc. a subsidiary of R1 RCM Inc., attached hereto as Exhibit "2" for the administration, processing and collection of all EMS patient medical billing and related professional services on behalf of the City of Tamarac Fire Rescue Department for a term effective upon execution of the Amendment "2" through September 30, 2021 and allowing for subsequent renewals terms based on any potential re-negotiation and upon satisfactory performance and mutual agreement of both parties. SECTION 3: The City Manager is hereby authorized to approve any subsequent renewals of Amendment "2" to the Agreement with ADPI upon satisfactory performance, re-negotiation of terms and mutual agreement of both parties. SECTION 4: That all Resolutions or parts of Resolutions in conflict herewith are hereby repealed to the extent of such conflict. SECTION 5: If any clause, section, other part or application of this Resolution is held by any court of competent jurisdiction to be unconstitutional or invalid, in part or application, it shall not affect the validity of the remaining portions or applications TR#13321 August 1, 2019 Page 4 of this Resolution. SECTION 6: This Resolution shall become effective immediately upon its passage and adoption. gi PASSED, ADOPTED AND APPROVED this day of (I) 2019. 7'7( ; c� MICH LLE GOMEZ, MAYOR ATTEST: PATRICIA TEUFEL, CMC CITY CLERK .i RECORD OF COMMISSION VOTE: MAYOR GOMEZ DIST 1: COMM. BOLTON DIST 2: COMM. GELIN DIST 3: COMM. FISHMAN DIST 4: V/M PLACKO I HEREBY CERTIFY THAT I HAVE APPROVED THIS RESOLUTION AS TO FORM 77 (7,AC2:, ii)V.Dr_ : SAMUEL S. GORN CITY ATTORNEY Exhibit 1 DEPARTMENT OF HEALTH&HUMAN SERVICES Centers for Medicare&Medicaid Services Atlanta Regional Office 61 Forsyth Street,Suite 4T20 Atlanta,Georgia 30303 CENTERS FOR MEDICARE&MEDICAID SERVICES DIVISION OF MEDICAID&CHILDREN'S HEALTH OPERATIONS October 20,2016 Beth Kidder Acting Deputy Secretary for Medicaid Agency for Health Care Administration 2727 Mahan Drive, Mailstop#20 Tallahassee, FL 32308 ATTN: April Cook RE: Title XIX State Plan Amendment 15-0014 Dear Ms. Kidder: We have reviewed the proposed amendment to the Florida State Plan,submitted under transmittal number FL 15-0014. This amendment implements a new supplemental payment methodology for a certified public expenditure program for emergency medical transportation services. Based on the information provided, this amendment was approved on October 20,2016. The effective date is October 1, 2015. We are enclosing the approved form HCFA 179 and plan pages. If you have any questions, please contact Sid Staton at 850-878-3486 or by email at sidney.statona,cros.hhs.gov. Sincerely, //s// Jackie Glaze Associate Regional Administrator Division of Medicaid & Children's Health Operations Enclosure DEPARTMENT OF HEALTH AND HUMAN SERVICES DORM AI'PKOV.ED IrEALTH CARE FINANCING ADMINISTRATION OMn NO.O0384U191 TRANSMITTAL AND NOTICE OF APPROVAL OF 1.TRANSMITTAL NUMBER: . 2.STATE STATE PLAN MATERIAL 2015-014 Florida j FOR:HEALTH CARE,.FINANC,ING AI)MINIS I RA'1.'ION 3.PROGRAM IDENTIFICATION:'TITLE XIX OF. SECURITY ACT(MEDICAID) FM:REGIONAL ADMINISTRATOR 4.PROPOSED EF.FE.CTIVE DATE HEALTH CARE FINANCING ADMINISTRATION October 1,2015 DEPARTMENT OF HEALTH AND HUMAN SERVICES 5.TYPE OF PLAN MATERIAL(Check One): ❑NEW STATE PLAN ❑AMENDMENT TO BE CONSIDERED AS NEW PLAN ®AMENDMENT COMPLETE BLOCKS 6 THRU 10[F THIS IS AN AMENDMENT(Separate Transmittal for each amendment) 6.FEDERAL STATUTE/REGULATION CITATION: 7.FEDERAL BUDGET IMPACT:(in thousands) 42 CFR 431.53 FFY 2015-2016 $15,000 FFY 2016-2017 $15,000 8.PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT: 9.PAGE NUMBER OF THE SUPERSEDED PLAN SECTION New:page 34a-34b of 4.19-B OR ATTACHMENT(lf Applicahlr): 10.SUBJECT OF AMENDMENT: Certified Public Expenditure Program for Emergency Transportation. I I.GOVERNOR'S REVIEW(Check One): ❑GOVERNOR'S OFFICE REPORTED NO COMMENT ®OTHER,AS SPECIFIED: ❑COMMENTS OF GOVERNOR'S OFFICE ENCLOSED Reviewed by the Deputy Secretary for Medicaid ❑NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL who is the Governor's designee. 12.SIGNATURE OF STATE AGENCY OFFICIAL: 16. RETURN TO: _ + I/s/I Mr.Justin M.Senior 13.TYPED NAME: Deputy Secretary for Medicaid Mr.Justin M.Senior Agency for Health Care Administration 14.TITLE: Deputy Secretary for Medicaid 2727 Mahan Drive,Mail Stop#8 Tallahassee, FL 32308 15. DATE SUBMITTED: 12-15-15 Attention:April Cook 41�RE tk)NAL, kfIcE uS FONLY 17 'DATE RECEIV$I7: 12 14 15 t V, . # * 4 18 D E�APPROVED:10-20-16 ]9 I FRC7'IVE ' ' t , ti.41 4 i1 V E'® RE t TtONAL OFFICIAL: Ib-p3`1 7 E 1r� � � A � 4kaa�w4 tl � kts n 45 J s 2 1 YPED 23. N AE. yd : 1I $ AssoceR gto Xadminraor :Jackie Glaze• HealthOpns. k • KEMAtKS Ap o i eiEitied631i s140 o Nif4s,c107 l 16: Block#8 changed toread At '4 i' n 4} i • 010 444qagd04f $ s r S? z .. �-' -+ -t s- - n- sea �t ux ;ate ah- �'".�� Ls����A � '�` a - a . FORM HCFA-179 (07-92) Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS This program provides supplemental payments for eligible Public Emergency Medical Transportation (PEMT) entities that meet specified requirements and provide emergency medical transportation services to Medicaid beneficiaries. Supplemental payments provided by this program are available only for allowable costs that are in excess of other Medicaid revenue that the eligible PEMT entities receive for emergency medical transportation services to Medicaid eligible recipients. Eligible PEMT entities must provide to the Agency for Health Care Administration (AHCA) certification for the total expenditure of funds and certification of federal financial participation (FFP) eligibility for the amount claimed. Providers must submit as-filed cost reports for the previous State fiscal year(SFY) by November 30 of the current SFY. Following the cost report submission, the corresponding lump-sum payments will be disbursed annually prior to the certified forward period of the current SFY (September 30). For example, cost reports with data covering SFY 2014-15 must be submitted by November 30, 2015. AHCA will then review the SFY 2014-15 submission and process a payment prior to September 30, 2016. Payments will not be disbursed as supplemental increases to current reimbursement rates for specific services. Costs will be identified through the Centers for Medicare and Medicaid Services (CMS) approved cost report. Costs covered will include the following applicable Medicaid emergency services: Ambulance Services: both Basic Life Support and Advanced Life Support, Advanced Life Support Level 2, and Specialty Care Transport(SCT). Services must be provided by fire rescue or ambulance services. This supplemental payment program will be in effect beginning October 1, 2015. A. Definitions 1. "Direct costs" means all costs that can be identified specifically with a particular final cost objective in order to meet medical transportation mandates. 2. "Indirect costs" means costs for a common or joint purpose benefitting more than one cost objective that are allocated to each benefiting objective using AHCA approved indirect rate or an allocation methodology. Indirect costs rate or allocation methodology must comply with OMB Circular A-87 and CMS non-institutional reimbursement policy. 3. "PEMT entity" is determined to be eligible if it is a county, city, healthcare district, or public university in Florida and provides emergency medical transportation services for Medicaid beneficiaries. Amendment: 2015-014 Effective: 10/01/15 Supersedes: New Approved: 10-20-16 34a Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS 4. "PEMT services" means both the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient, as well as the advanced life support, advanced life support II, basic life support, and specialty care transport services provided to an individual by PEMT providers before or during the act of transportation. a. "Advanced life support" means the assessment or treatment through the use of techniques described in the Emergency Medical Technician (EMT)-Paramedic: National Standard Curriculum or the National Emergency Medical Services (EMS) Education Standards, provided by an emergency medical technician- intermediate or EMT-Paramedic. These are special services designed to provide definitive prehospital emergency medical care, including but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration with drugs and other medicinal preparations, and other specified techniques and procedures. b. "Advanced life support level 2" means transportation by ground ambulance vehicle and the provision of medically necessary supplies and services, including one of the following: •At least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids). • Provision of manual defibrillation/cardioversion, endotracheal intubation, central venous line, cardiac pacing, chest decompression, surgical airway, or intraosseous line. c. "Basic life support" means the assessment or treatment through the use of techniques described in the EMT-Basic National Standard Curriculum or the National EMS Education Standards. It includes emergency first aid and cardiopulmonary resuscitation procedures to maintain life without invasive techniques. d. "Specialty care transport" means the inter-facility transportation of a critically injured or ill recipient by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic that must be furnished by one or more health professionals in an appropriate specialty area. 5. "Shared direct costs" are direct costs that can be allocated to two or more departmental functions on the basis of shared benefits. Amendment: 2015-014 Effective: 10/01/15 Supersedes: New Approved: 10-20-16 34b Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS This program provides supplemental payments for eligible Public Emergency Medical Transportation (PEMT) entities that meet specified requirements and provide emergency medical transportation services to Medicaid beneficiaries. Supplemental payments provided by this program are available only for allowable costs that are in excess of other Medicaid revenue that the eligible PEMT entities receive for emergency medical transportation services to Medicaid eligible recipients. Eligible PEMT entities must provide to the Agency for Health Care Administration (AHCA) certification for the total expenditure of funds and certification of federal financial participation (FFP)eligibility for the amount claimed. Providers must submit as-filed cost reports for the previous State fiscal year (SFY) by November 30 of the current SFY. Following the cost report submission, the corresponding lump-sum payments will be disbursed annually prior to the certified forward period of the current SFY (September 30). For example, cost reports with data covering SFY 2014-15 must be submitted by November 30, 2015. AHCA will then review the SFY 2014-15 submission and process a payment prior to September 30, 2016. Payments will not be disbursed as supplemental increases to current reimbursement rates for specific services. Costs will be identified through the Centers for Medicare and Medicaid Services (CMS) approved cost report. Costs covered will include the following applicable Medicaid emergency services: Ambulance Services: both Basic Life Support and Advanced Life Support, Advanced Life Support Level 2, and Specialty Care Transport (SCT). Services must be provided by fire rescue or ambulance services. This supplemental payment program will be in effect beginning October 1, 2015. A. Definitions 1. "Direct costs" means all costs that can be identified specifically with a particular final cost objective in order to meet medical transportation mandates. 2. "Indirect costs" means costs for a common or joint purpose benefitting more than one cost objective that are allocated to each benefiting objective using AHCA approved indirect rate or an allocation methodology. Indirect costs rate or allocation methodology must comply with OMB Circular A-87 and CMS non-institutional reimbursement policy. 3. "PEMT entity" is determined to be eligible if it is a county, city, healthcare district, or public university in Florida and provides emergency medical transportation services for Medicaid beneficiaries. Amendment: 2015-014 Effective: 10/01/15 Supersedes: New Approved: 34a Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS 4. "PEMT services" means both the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient, as well as the advanced life support, advanced life support II, basic life support, and specialty care transport services provided to an individual by PEMT providers before or during the act of transportation. a. "Advanced life support" means the assessment or treatment through the use of techniques described in the Emergency Medical Technician (EMT)-Paramedic: National Standard Curriculum or the National Emergency Medical Services (EMS) Education Standards, provided by an emergency medical technician- intermediate or EMT-Paramedic. These are special services designed to provide definitive prehospital emergency medical care, including but not limited to, cardiopulmonary resuscitation, cardiac monitoring,cardiac defibrillation, advanced airway management, intravenous therapy, administration with drugs and other medicinal preparations, and other specified techniques and procedures. b. "Advanced life support level 2" means transportation by ground ambulance vehicle and the provision of medically necessary supplies and services, including one of the following: •At least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids). • Provision of manual defibrillation/cardioversion, endotracheal intubation, central venous line, cardiac pacing, chest decompression, surgical airway, or intraosseous line. c. "Basic life support" means the assessment or treatment through the use of techniques described in the EMT-Basic National Standard Curriculum or the National EMS Education Standards. It includes emergency first aid and cardiopulmonary resuscitation procedures to maintain life without invasive techniques. d. "Specialty care transport" means the inter-facility transportation of a critically injured or ill recipient by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic that must be furnished by one or more health professionals in an appropriate specialty area. 5. "Shared direct costs" are direct costs that can be allocated to two or more departmental functions on the basis of shared benefits. Amendment: 2015-014 _ Effective: 10/01/15 Supersedes: New Approved: 34b Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS B. Supplemental Payment Methodology Supplemental payments provided by this program to an eligible PEMT entity will consist of FFP for Medicaid uncompensated emergency medical transportation costs based on the difference between the Medicaid reimbursement amount and the providers actual cost for providing emergency medical transportation services to eligible Medicaid beneficiaries. The supplemental payment methodology is as follows: 1. As described in Section D, the expenditures certified by the eligible PEMT entity to AHCA will represent the payment eligible for FFP. Allowable certified public expenditures will determine the amount of FFP claimed. 2. In no instance will the amount certified pursuant to Paragraph D.1, when combined with the amount received for emergency medical transportation services pursuant to any other provision of this State Plan or any Medicaid waiver granted by CMS, exceed 100 percent of the allowable costs for such emergency medical transportation services. 3. Pursuant to Paragraph D.1, the eligible PEMT entity will annually certify to AHCA the total costs for providing emergency medical transportation services for Medicaid beneficiaries offset by the received Medicaid payments for the previous state fiscal year. The supplemental Medicaid reimbursement received pursuant to this segment of the State Plan will be distributed in one annual lump-sum payment after submission of such annual certification. 4. For the subject year, the emergency medical transportation service costs that are certified pursuant to Paragraph D.1 will be computed in a manner consistent with Medicaid cost principles regarding allowable costs, and will only include costs that satisfy applicable Medicaid requirements. 5. Computation of allowable costs and their allocation methodology must be determined in accordance with the CMS Provider Reimbursement Manual (CMS Pub. 15-1), CMS non-institutional reimbursement policies, and OMB Circular A-87, which establish principles and standards for determining allowable costs and the methodology for allocating and apportioning those expenses to the Medicaid program, except as expressly modified below. 6. Medicaid base payments to the PEMT providers for providing PEMT services are derived from the Medical Transportation fee-schedule established for reimbursements payable by the Medicaid program by procedure code. The base payments for these eligible PEMT providers are fee-for-service (FFS) payments. The primary source of paid claims data and other Medicaid reimbursements is the Florida Medicaid Management Information System (FLMMIS). The number of paid Amendment: 2015-014 Effective: 10/01/15 Supersedes: New Approved: 34c Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS Medicaid FFS PEMT transports is derived from and supported by the FLMMIS reports for services during the applicable service period. 7. For each eligible PEMT provider in this supplemental program, the total uncompensated care costs available for reimbursement will be no greater than the shortfall resulting from the allowable costs calculated using the Cost Determination Protocols (Section C.). Each eligible PEMT provider must provide PEMT services to Medicaid beneficiaries in excess of payments made from the Medicaid program and all other sources of reimbursement for such PEMT services provided to Medicaid beneficiaries. Eligible PEMT providers that do not have any uncompensated care costs will not receive a supplemental payment under this supplemental reimbursement program. C. Cost Determination Protocols 1. An eligible PEMT provider's specific allowable cost per-medical transport rate will be calculated based on the provider's audited financial data reported on the CMS- approved cost report. The per-medical transport cost rate will be the sum of actual allowable direct and indirect costs of providing medical transport services divided by the actual number of medical transports provided for the applicable service period. a. Direct costs for providing medical transport services include only the unallocated payroll costs and fringe benefits for the shifts in which personnel dedicate 100 percent of their time to providing medical transport services, medical equipment and supplies, and other costs directly related to the delivery of covered services, such as first-line supervision, materials and supplies, professional and contracted services, capital outlay, travel, and training. These costs must be in compliance with Medicaid non-institutional reimbursement policy and are directly attributable to the provision of the medical transport services. b. Shared direct costs for emergency medical transport services, as defined by Paragraph A.5., must be allocated for salaries and benefits and capital outlay. The salaries and benefits will be allocated based on the percentage of total hours logged performing EMT activities versus other activities. The capital related costs will be allocated based on the percentage of total square footage. c. Indirect costs are determined by applying the cognizant agency specific approved indirect cost rate to its total direct costs (Paragraph A.1.) or derived from provider's approved cost allocation plan. For eligible PEMT providers that do not have a cognizant agency approved indirect cost rate or approved cost allocation plan, the costs and related basis used to determine the allocated indirect costs must be in compliance with OMB Circular A-87, Amendment: 2015-014 Effective: 10/01/15 Supersedes: New Approved: 34d Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS Medicare Cost Principle (42 CFR 413 and Medicare Provider Reimbursement Manual Part 1 and Part 2), and Medicaid non-institutional reimbursement policy. d. The PEMT provider specific per-medical transport cost rate is calculated by dividing the total net medical transport allowable costs (Paragraphs A.1. and A.2.) of the specific provider by the total number of medical transports as reported in the transportation daily logs provided by the PEMT provider for the applicable service period. 2. Medicaid's portion of the total allowable cost for providing PEMT services by each eligible PEMT provider is calculated by multiplying the total number of Medicaid FFS PEMT transports provided by the PEMT provider's specific per-medical transport cost rate (Paragraph C.1.d.)for the applicable service period. D. Responsibilities and Reporting Requirements of the Eligible PEMT Entity An eligible PEMT entity must do all of the following: 1. Certify that the claimed expenditures for emergency medical transportation services made by the eligible PEMT entity are eligible for FFP. 2. Provide evidence supporting the certification as specified by AHCA. 3. Submit data as specified by AHCA to determine the appropriate amounts to claim as qualifying expenditures for FFP through the CMS approved cost report and cost identification methodology. 4. Keep, maintain, and have readily retrievable any records required by AHCA or CMS. E. AHCA's Responsibilities 1. AHCA will submit claims for FFP for the expenditures for services that are allowable expenditures under federal law. 2. AHCA will, on an annual basis, submit to the federal government any necessary materials, including but not limited to the CMS approved cost report, in order to provide assurances that FFP will include only those expenditures that are allowable under federal law. F. Interim Supplemental Payment 1. AHCA will make annual interim Medicaid supplemental payments to eligible PEMT providers. The interim supplemental payments for each provider are based on the Amendment:2015-014 Effective: 10/01/15 Supersedes: New Approved: 34e Attachment 4.19-B SUPPLEMENTAL PAYMENT FOR PUBLICLY OWNED OR OPERATED EMERGENCY MEDICAL TRANSPORTATION PROVIDERS provider's completed annual cost report in the format prescribed by AHCA and approved by CMS for the applicable cost reporting year. AHCA will make adjustments to the as-filed cost report based on the results of the most recently retrieved FLMMIS report. 2. Each eligible PEMT provider must compute the annual cost in accordance with the Cost Determination Protocols (Section C.) and must submit the completed annual as-filed cost report to AHCA five months after the close of the SFY. 3. The interim supplemental payment is calculated by subtracting the total Medicaid base payments (Paragraph B.6.) and other payments, such as Medicaid co- payments, received by the providers for PEMT services to Medicaid beneficiaries from the Medicaid portion of the total PEMT allowable costs(Paragraph C.2.) reported in the as-filed cost report or the as-filed cost report adjusted by AHCA (Paragraph F.1.). G. Final Reconciliation 1. Providers must submit auditable documentation to AHCA within two years following the end of the state fiscal year in which payments have been received. AHCA will perform a final reconciliation where it will settle the provider's annual cost report as audited, three years following the State fiscal year end.AHCA will compute the net Medicaid PEMT allowable cost using audited per-medical transport cost, and the number of Medicaid FFS PEMT transports data from the updated FLMMIS reports. Actual net Medicaid allowable cost will be compared to the total base and interim supplemental payments and settlement payments made, and any other source of reimbursement received by the provider for the period. 2. If at the end of the final reconciliation it is determined that the PEMT provider has been overpaid, the provider will return the overpayment to AHCA, and AHCA will return the overpayment to the federal government pursuant to 42 CFR 433.316. If at the end of the final reconciliation it is determined that the PEMT provider has been underpaid, the PEMT provider will receive a final supplemental payment in the amount of the underpayment. 3. All cost report information for which Medicaid payments are calculated and reconciled are subject to CMS review and must be furnished upon request. Amendment: 2015-014 Effective: 10/01/15 Supersedes: New Approved: 34f EMERGENCY MEDICAL TRANSPORTATION SERVICES COST REPORT 1. DEFINITIONS Adjustment- Entry to adjust expenses. Emergency Medical Technician (EMT) Services- Both the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient, as well as the advanced, limited-advanced, and basic life support services provided to an individual by public emergency medical transportation (PEMT) entities before or during the act of transportation. Emergency Medical Technician Transport-Emergency medical transportation services provided by eligible PEMT entities to individuals as defined in the Certified Public Expenditure Program for Emergency Medical Transportation, State Plan Amendment(SPA) Eligible PEMT Entity- Entity that is eligible to receive supplemental reimbursement under this supplement because it meets all of the following requirements continuously during the claiming period: • Provides EMT services to recipients. • Is enrolled as a Florida Medicaid provider during the period being claimed. • Is owned or operated by an eligible governmental entity, to include the state, city, county, and fire protection district. Medical Transportation Service(MTS) -Transportation to secure medical examinations and treatment for an individual. Reclassification of Expense- Entry that transfers costs from one cost center or schedule to another. Service Period— Fiscal year (July 1 through June 30). Shift-Standard period of time assigned for a complete cycle of work, as set by each eligible PEMT entity. 2. REPORT SUBMISSION 1. Each eligible PEMT entity must submit a fully completed Centers for Medicare and Medicaid Services(CMS) cost report to the Agency for Health Care Administration (AHCA) no later than five months after the last day of the fiscal year. 2. Each eligible PEMT entity must maintain fiscal and statistical records for the service period covered by the cost report. All records must be accurate and sufficiently detailed to substantiate the cost report data. Public emergency medical transportation entities must retain all necessary records for a minimum of seven years after the end of the quarter in which the cost reports were submitted to AHCA. If an audit is in progress, all records relevant to the audit must be retained until completed, or the final resolution of all audit exceptions, deferrals, and disallowances. 3. Public emergency medical transportation entities must maintain a copy of the signed and electronic version of the cost report and all supporting documentation following the review and acceptance of the cost report. Pursuant to the timeframes outlined in SPA , the Agency will contact PEMT entities individually to schedule audits. 4. Services rendered to recipients enrolled in a Florida Medicaid Managed Care Plan or to recipients who have coverage under both Medicare and Medicaid programs (dually eligible recipients) are not eligible for reimbursement under this supplement. 3. REPORTING REQUIREMENTS Public emergency medical transportation entities must comply with the following reporting requirements: • Public emergency medical transportation entities may only report costs for services provided to Florida Medicaid recipients on, or after, October 1, 2015. • Public emergency medical transportation entities must exclude administrative costs incurred for reimbursing AHCA's administration costs from this cost report. All costs must be reported in accordance with all of the following: 1. The allowable costs determined in accordance with the methodology specified in SPA , incorporated by reference, and available at http://ahca.mvflorida.com/Medicaid/review/index.shtml. 2. Medicare cost reimbursement principles specified in 42 Code of Federal Regulations (CFR), Part 413, and Section 1861 of the Social Security Act(42 USC, Section 1395x). 3. Centers for Medicare and Medicaid Services Provider Reimbursement Manual (CMS Pub. 15-1), incorporated by reference and available at https://www.cros.gov/Requlations-and- Guidance/Guidance/Manuals/Paper-Based-Manuals- Items/CMS021929.html?DLPaqe=1&DLEntries=10&DLFilter=15- 1&DLSort=0&DLSortDir=ascending. 4. Data and cost reporting principles specified in Chapter 401, Florida Statutes. Reported costs that do not comply with the principles specified in these provisions are subject to review by AHCA and will be adjusted accordingly. 5. Allowable costs specified in OMB Circular A-87, incorporated by reference, and available at http://www.whitehouse,00v/omb/circulars a087 2004/. 4. COMPLETING THE REPORT General Information and Certifies the EMT Claim Packet Certification Schedule 1 Schedule of Total Expense Schedule 2 Medical Transportation Services(MTS) Expense Schedule 3 Non-Medical Transportation Services Expense Schedule 4 Allocation of Capital Related and Salaries & Benefits Expense Schedule 5 Allocation General of Administration and (A&G) Schedule 6 Reclassifications of Expenses Schedule 7 Adjustments to Expenses Schedule 8 Revenues Schedule 9 Final Settlement Schedule 10 Notes GENERAL INFORMATION AND CERTIFICATION Public emergency medical transportation entities must complete items 1-27. An officer or administrator must sign the certification statement on the original report in blue ink. Any submitted cost reports that are not clear and legible, are altered,or incomplete: or not signed will be rejected and returned with instructions noting the deficiencies in need of correction. Cost reports that are not accepted by the required filing deadline due to improper completion will be rejected. PROVIDER COST REPORT QUESTIONNAIRE Public emergency medical transportation entities must complete items A-C. The Provider Cost Report Questionnaire should identify which financial records each public emergency medical transportation entity is using to allocate costs. SCHEDULE 1 —TOTAL EXPENSE No input is necessary on this schedule to reflect all allowable costs incurred.All numbers will auto- calculate from other schedules. SCHEDULE 2— MEDICAL TRANSPORTATION SERVICES EXPENSE Enter total unallocated direct expenses incurred from providing 100% MTS during each shift. Do not enter expenses for multiple activities(i.e. "shared"services) as 100% MTS. These expenses must be allocated on Schedule 4. For staff that responds to both MTS transports and non-MTS transports activities (i.e.firefighters), salary and fringe benefit expenses for that staff must be reported in Schedule 4 as allocated costs. Column 1 Enter all costs 100% associated with MTS. Column 2 No input necessary, information will populate from Schedule 4. Column 3 No input necessary, information will populate from Schedule 6. Column 4 No input necessary, information will populate from Schedule 7. Column 5 No input necessary, information will auto-calculate. SCHEDULE 3 - NON-MEDICAL TRANSPORTATION SERVICES EXPENSE Column 1 Enter all costs 100% associated with non-MTS. Column 2 No input necessary, information will flow from Schedule 4. Column 3 No input necessary, information will flow from Schedule 6. Column 4 No input necessary, information will flow from Schedule 7. Column 5 No input necessary, information will auto-calculate. SCHEDULE 4 -ALLOCATION OF CAPITAL RELATED AND SALARIES& BENEFITS Column 1 Enter all capital related, salary and benefit costs that are not directly assigned to MTS and non-MTS services. Column 2 No input necessary, information will populate from Schedule 6. Column 3 No input necessary, information will populate from Schedule 7. Column 4-6 No input necessary, information will auto-calculate. At the bottom on Schedule 4, identify the appropriate statistic(square footage or hours spent)that pertain to MTS services and non-MTS services in the yellow highlighted boxes. SCHEDULE 5 - ALLOCATION OF ADMINISTRATIVE AND GENERAL Column 1 Enter all administrative and general costs that are not directly assigned to MTS and non-MTS services. Column 2 No input necessary, information will flow from Schedule 6. Column 3 No input necessary, information will flow from Schedule 7. Column 4-6 No input necessary, information will auto-calculate. SCHEDULE 6 - RECLASSIFICATIONS Public emergency medical transportation entities must reclassify an expense when it has been improperly classified, and include an explanation for each reclassification in the column labeled "Explanation of Entry." Column 1: Enter sequential lettering system to identify individual reclassifications (i.e. A. B. C...) Column 2 Enter cost center this is increasing. Column 3 Enter line number of schedule the increase pertains to. Column 4 Enter schedule number the increase pertains to. Column 5 Enter the amount of increase. Column 6 Enter cost center that is decreasing. Column 7 Enter line number of schedule the decrease pertains to. Column 8 Enter schedule number the decrease pertains to. Column 9 Enter the amount of decrease. The increased total must equal the decreased total at the bottom of this schedule. SCHEDULE 7 - ADJUSTMENTS Enter in Schedule 7. SCHEDULE 8 -REVENUES/ FUNDING SOURCES: AREA A Column 1 Enter Florida Medicaid FFS revenue type. Column 2-5 Enter dollar amount for revenue received. Column 6 No input necessary, information will auto-calculate. AREA B Column 1 Enter other Florida Medicaid FFS revenue type. Column 2-5 Enter dollar amount for revenue received. Column 6 No input necessary, information will auto-calculate. AREA C Column 1 Enter total revenue (i.e. Florida Medicaid payments, tax revenue, grants, etc.) received and list the funding source. Column 2 Enter revenue amount if it is MTS specific. Column 3 Enter revenue amount if it is non-MTS specific. Column 4 No input necessary, information will auto-calculate. SCHEDULE 9 -FINAL SETTLEMENT Row 1 No input necessary, cost of MTS will auto-calculate from Schedule 2. Row 2 Indicate if the indirect cost factor was based on MTS. Row 3 If the answer for Row 2 above was NO, enter the base costs for calculating the indirect cost. Row 4 Enter the indirect cost factor. In most cases, when an indirect cost factor is being applied, there should be no A&G cost allocated. Row 5 No input necessary, information will auto-calculate. Row 6 No input necessary, information will auto-calculate. Row 7 No input necessary, information will auto-calculate. Row 8 Enter the total number of MTS for the reporting period; by quarter where applicable. Row 9 No input necessary, the average cost per medical transport will auto-calculate. Row 10 No input necessary, FFS transports will auto-calculate for the corresponding quarter. Row 11 No input necessary, total costs of Florida Medicaid emergency medical transports will auto- calculate. Row 12 No input necessary, Florida Medicaid FFS revenue will auto-calculate for the corresponding quarters. Note: The amount will be a negative value. Row 13 No input necessary, net cost of services for the corresponding quarter will auto-calculate. Row 14 No input necessary, federal financial participation reduction will auto-calculate for the corresponding quarter. Row 15 No input necessary, net amount due to the PEMT Entity will auto-calculate. SCHEDULE 10 - NOTES Identify any contracting arrangements for expenditures reported on Schedules 1-5, the statistical basis for allocation on Schedules 4 and 5, and reasons for any schedules left blank. 5. FILING DEADLINE 1. The Agency for Health Care Administration may approve an extension of the filing deadline when a PEMT entity's operations are significantly or adversely affected due to extraordinary circumstances,which the PEMPT entity has no control over, such as, flood or fire. Public emergency medical transportation entities must submit a written request for an extension including a detailed explanation of the circumstances supporting the need for additional time postmarked within the five months after the last day of the applicable fiscal year. 2. ELECTRONIC SUBMISSION OF ANNUAL COST REPORTS—email the signed Adobe PDFTM version, the ExcelT"" version, and any supporting documentation when using an Indirect Cost Factor on Schedule 9 to LIPProvidersReports@ahca.myflorida.com. • EXHIBIT 2 — TR#13321 SECOND AMENDMENT TO AGREEMENT FOR MEDICAL BILLING SERVICES FOR FIRE RESCUE THI C ND AMENDMENT (the "Second Amendment") is made and entered into this day of 019 (the "Amendment Effective Date") by and between City of Tamarac, a municipal corporation of the State of Florida ("City") and Advanced Data Processing, Inc. (ADPI), a subsidiary of R1 RCM Inc., a Delaware corporation ("Contractor"). WHEREAS, City and Contractor are parties to an Agreement for Medical Billing Services for Fire Rescue, effective October 1, 2016, as amended by that certain Amendment 1 to Agreement for Medical Billing Services for Fire Rescue made effective October 26, 2016 ("Amendment 1"together with the Agreement for Medical Billing Services for Fire Rescue referred to collectively as the "Agreement"); WHEREAS, R1 RCM Inc. acquired Intermedix Corporation and all of its subsidiaries including ADPI in 2018; and WHEREAS, the parties desire to change the Public Emergency Medical Transport (PEMT) fee. NOW THEREFORE, in consideration of the foregoing, the mutual promises and covenants hereinafter set forth, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Wherever in the Agreement the term "Advanced Data Processing, Inc., a subsidiary of Intermedix Corporation" appears, such term shall be replaced with "Advanced Data Processing, Inc., a subsidiary of R1 RCM Inc." and Section 11 Notice shall be amended to read as follows: To CONTRACTOR: Advanced Data Processing, Inc. do R1 RCM Inc. 401 N. Michigan Avenue, Suite 2700 Chicago, IL 60611 Attn: Legal Department 2. Exhibit 2 (CPE-ASPP Program Scope of Consulting Services and Revenue Recognition Process) and Exhibit 2-A (Fees) shall be deleted in their entirety and replaced with the attached Exhibit 2 (CPE-ASPP Program Scope of Consulting Services and Revenue Recognition Process) and Exhibit 2-A (Fees) to reflect the new Term and PEMT fee. 3. Capitalized terms not otherwise defined in this Supplement shall have the meanings ascribed to such terms in the Agreement. All terms and conditions of the Agreement are hereby ratified and shall remain in full force and effect except to the extent this Supplement expressly modifies or is inconsistent with the terms and conditions of the Agreement, in which case the terms of this Supplement shall be controlling. 4. Add new Section 22 to Agreement titled "Scrutinized Companies" "22. Scrutinized Companies PAGES By execution of this Agreement, in accordance with the requirements of F.S. 287.135 and F.S. 215.473, Contractor certifies that Contractor is not participating in a boycott of Israel. Contractor further certifies that Contractor is not on the Scrutinized Companies that Boycott Israel list, not on the Scrutinized Companies with Activities in Sudan List, and not on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has Contractor been engaged in business operations in Syria. Subject to limited exceptions provided in state law, the City will not contract for the provision of goods or services with any scrutinized company referred to above. Submitting a false certification shall be deemed a material breach of contract. The City shall provide notice, in writing, to Contractor of the City's determination concerning the false certification. Contractor shall have five (5) days from receipt of notice to refute the false certification allegation. If such false certification is discovered during the active contract term, Contractor shall have ninety (90) days following receipt of the notice to respond in writing and demonstrate that the determination of false certification was made in error. If Contractor does not demonstrate that the City's determination of false certification was made in error then the City shall have the right to terminate the contract and seek civil remedies pursuant to Section 287.135, Florida Statutes, as amended from time to time." Remainder of Page Intentionally Blank PAGE 2 IN WITNESS OF, the parties have executed this Second Amendment to the above-referenced Agreement effective as of the Effective Date. CITY: CONTRACTOR: CITY OF TAMARAC ADVANCED DATA PROCESSING, INC. , A SUBSIDIARY OF R1 RCM, INC. 1/, By: /`/4vti Name: 114(SNekel - Ccr/err Name: 1 i ' S/ W fry t��, Title: 0rt• u Title: L L2 P ATTEss 47/5 City Clerk APPR V D AS TO F RM AND CONTENT: City'Attorney \\`\\ TANIq,4 0,. �gTA130S :• o /I,,,,1,1110` PAGE 3 Exhibit 2 Description of Consulting Services and Revenue Recognition Process • Term of Consulting Services: Co-terminus with Agreement to September 30, 2021, as may be extended pursuant to the provisions contained therein." • Drafting application materials and responding to requests for additional information necessary for the provider to gain approval to participate in the Ambulance Supplemental Payment Programs. • Preparing a fiscal impact study and presenting results to department/state stakeholders to demonstrate benefits of a Continuing Public Expenditure ("CPE") Program and uninsured CPE (if applicable) program to the provider. • Identifying eligible costs and developing appropriate cost allocation methodologies to report only allowable costs for providing emergency medical services to Medicaid and, as applicable, uninsured populations. • Preparing the annual Medicaid cost report for EMS on behalf of provider. • Conducting analysis of the provider's financial and billing data in order to prepare and submit annual cost reports, the mechanism for providers to receive additional revenue under Ambulance Supplemental Payment Programs. • Providing comprehensive desk review support, including but not limited to conducting reviews of all cost settlement files, performing detailed analysis of billing reports generated by Medicaid agencies to ensure that all allowable charges and payments are encompassed in the calculation of the final settlement, and drafting letters and providing supporting documentation to meet Medicaid requirements and expedite settlement. • Determining enhanced supplemental payments realized by provider, as necessary. • Conducting comparative analysis to identify significant trends in billing and financial data. • Providing charge master review to ensure that the provider is optimizing charges to drive revenue generation. • Meeting with the Florida Agency for Health Care Administration (AHCA) and City to further develop the supplemental payments program for uninsured patient transports. • Respond to, and represent City on any AHCA or CMS audit, review or communication regarding any PEMT cost report prepared by Contractor and delivered to AHCA on behalf of the City. PAGE 4 Appendix 2-A FEES All revenue realized by the City from the Certified Public Expenditure (CPE) Program for Emergency Medical Services shall be paid in full directly to City. Revenue realized as a result of the Certified Public Expenditures (CPE) for Emergency Medical Services (EMS) shall be determined by the Medicaid cost settlement determined through the Medicaid cost report. Contractor will not receive any compensation until the CPE for Emergency Medical Services settlement revenues are received by the City. Contractor will invoice and receive revenue upon the receipt of revenue received by City for the CPE for Emergency Medical Services. Contractor will invoice City based on the final CPE for Emergency Medical Services settlement within thirty (30) days of receipt of funds by the City. City will remit payment to Contractor within thirty (30) days of invoice receipt. Additional revenues generated for the uninsured patient population, will also be invoiced within thirty (30)days of receipt of revenues by the City. The contingency fees to be paid associated with the successful implementation and generation of incremental Medicaid revenues as a result of the CPE for Emergency Medical Services are twelve percent (12%) of City revenues. PAGE 5