To: Board of Directors
From: Lewis Broschard, Chief, Contra Costa County Fire Protection District
Report Title: PP-GEMT IGT Payment to California Department of Health Care Services for CY 2025
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
APPROVE and AUTHORIZE the Auditor-Controller to issue a payment, on behalf of the Fire Chief, to the State of California Department of Health Care Services (DHCS), in an amount not to exceed $9,000,000, for the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) for ambulance transports provided by the District as estimated during January 2025 through December of 2025; and AUTHORIZE the Fire Chief, or designee, to execute and submit the required IGT Certification Form’s each payment period for calendar year 2025.
FISCAL IMPACT:
The payment to the State of California Department of Health Care Services (DHCS) will be offset by the reimbursements from the new supplemental Medi-Cal program for public providers. The District anticipates that for all payments and fees paid to the DHCS, the District’s CCCFPD EMS Transport Fund will receive a net annual increase of $5 million to $7 million in additional supplemental reimbursements from this program. The fiscal impact is projected to be positive for the District's EMS Transport Fund due to the significant number of Medi-Cal transports within the District's ambulance operating area.
BACKGROUND:
In 2019, Assembly Bill 1705 (AB1705) was passed, and certain sections of the California Welfare and Institutions Code relating to Medi-Cal were amended and added. In accordance with the passage of the bill, the Department of Health Care Services (DHCS) developed the Public Provider Ground Emergency Medical Transport (PP-GEMT) Intergovernmental Transfer Program (IGT) to provide increased reimbursements by application of an add-on increase to emergency medical transports provided by eligible public GEMT providers. The non-federal share collected will be used to provide this add-on increase to the fee-for-services (FFS) fee schedule rate for the affected emergency medical transport billing codes and a rating increment that will be applied to primary capitation rates for contracted Medi-Cal plans. The new legislation requires the nonfederal share of any supplemental reimbursement provided under this program to be derived from voluntary intergovernmental transfers of local funds. Known to us as the “PP-GEMT IGT” program, this program will replace the current Quality Assurance Fee (QAF) and Ground Emergency Medical Transport (GEMT) Medi-Cal supplemental reimbursement programs. The bill requires eligible providers, including the Contra Costa County Fire Protection District, to receive an add-on increase to the associated Medi-Cal fee-for-service and managed care payments. The District has agreed to provide funding, along with all other public providers, to support the program's financial sustainability for the non-federal share of the program. The District anticipates the need to provide intergovernmental transfers to the state of approximately $9 million annually, which is currently scheduled to be paid in four installments during the calendar year 2025. The District anticipates total revenue from the program and the revised Medi-Cal reimbursements to be approximately $25 million annually, according to estimates provided by the District’s contracted medical billing firm. After accounting for the intergovernmental transfers and the dissolution of the QAF and GEMT supplemental reimbursement programs, it is anticipated the District will realize a net increase in total revenue in the range of $5 million to $7 million annually from the PP-GEMT IGT program. Contra Costa County Fire Protection District will be billed on the following schedule:
CONSEQUENCE OF NEGATIVE ACTION:
If the payments are not made, the State may withhold supplemental provider payments for ambulance services provided to Medi-Cal recipients.