To: Board of Supervisors
From: Lewis Broschard, Chief, Contra Costa County Fire Protection District
Report Title: Budget Amendment for PP-GEMT IGT revenue and expenses for FY 25-26
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
Acting as the governing board of the Contra Costa County Fire Protection District, APPROVE Budget Amendment No. BDA-25-00167 authorizing revenue and expenditure appropriations in the amount of $10,000,000 to make payments for the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) program for ambulance transports in FY 25-26.
FISCAL IMPACT:
Budget Amendment BDA-24-00167 will allocate $10,000,000 in additional cost recovery revenue and $10,000,000 in a special departmental expense account in the EMS Transport Fund.
The anticipated $10,000,000 PP-GEMT IGT payments will be offset by the reimbursements from the supplemental Medi-Cal program for public providers. The District anticipates that for all payments and fees paid to the Department of Health Care Services (DHCS), the District’s EMS Transport Fund will receive a net annual increase of $15 million in 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 $10 million in FY 25-26, which is currently scheduled to be paid in four installments during the fiscal year. 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.
CONSEQUENCE OF NEGATIVE ACTION:
If this action is not approved, the Fire District will be unable to make payments for PP-GEMT IGT. If the payments are not made, the State may withhold supplemental provider payments for ambulance services provided to Medi-Cal recipients.