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Agenda 07/14/2020 Item #16E 1 (Accept Direct Payments from Statewide Medicaid Managed Care (SMMC) Program07/14/2020 EXECUTIVE SUMMARY Recommendation for EMS to accept direct payments from the program named Statewide Medicaid Managed Care (SMMC), a supplemental Medicare payment program, in the amount up to $620,090.36 and to authorize Chairman to sign seven (7) Public Emergency Medical Transportation Uniform Increase Agreements with Florida Community Care, LLC, Humana Medical Plan, Inc., Molina Healthcare of Florida, Staywell, Sunshine State Health Plan, Inc., Vivida Health and Clear Health Alliance, and to approve the necessary budget amendments. OBJECTIVE: To accept direct payments in the amount of $620,090.36 from the program named Statewide Medicaid Managed Care (SMMC) to be used for Collier County Emergency Medical Services operations. BACKGROUND: In the 2019 General Appropriations Act, the Florida Legislature directed the Agency for Health Care Administration (Agency) to make direct payments to qualifying Public Emergency Medical Transportation (PEMT) providers for services under the Statewide Medicaid Managed Care (SMMC) program. The Agency submitted the 438.6(c) Pre-print uniform increase proposal to the Centers for Medicare and Medicaid Services (CMS) on August 30, 2019. On April 8th, the Agency for Health Care Administration (AHCA) received approval from the Centers for Medicare & Medicaid Services (CMS) for a Medicaid Managed Care (MCO) Public Emergency Medical Transportation (PEMT) supplemental payment program. This program allows for additional payments to medical providers for transports provided to Medicaid enrollees in the state of Florida. The PEMT program provides supplemental payments to eligible public entities that meet specific requirements and provide emergency medical transportation to Medicaid recipients. Collier County Emergency Medical Services has been identified as a PEMT provider and therefore is eligible for these payments. Medicaid payments are made to providers based on a set rate, which is less than the fees charged, leaving the provider with a balance that cannot be billed to the patient and is ultimately written off. This program was created to help offset the loss of revenue. Each PEMT provider will receive their estimated allocation during the course of the year which is subject to adjustment based on utilization. A reconciliation will be performed by ACHA annually which may adjust payments made by the SMMC program. CONSIDERATIONS: The State will provide SMMC with each participating PEMT provider’s allocation. Collier County’s projected amount is $620,090.36. The payments are made through an increase to the Medicaid rate. The increase is calculated based on prior year transports as well as projections for the current year’s population based on historical utilization. These funds, which are passed through The Agency for Health Care Administration (ACHA), made available by the Federal Government, will be available to the SMMC health plans, to distribute quarterly to qualified PEMT providers. This was approved by CMS (Center for Medicare and Medicaid Services). The SMMC health plans are required to have an agreement in place with the PEMT providers in their corresponding regions before payments are disbursed. Collier County EMS is located in Medicaid region eight. In region eight there are seven SMMC health plans that require a Public Emergency Medical Transportation Uniform Increase Agreement, which is an agreement that allows the same (uniform) increase in the rate that is paid out on each member enrolled in that managed care plan. The seven SMMC health plans in region eight that Collier County EMS is required to sign agreements with include: Florida Community Care, Humana Medical Plan, Molina Healthcare, Staywell, Sunshine Health, Vivida Health and Simply Healthcare. 16.E.1 Packet Pg. 2394 07/14/2020 FISCAL IMPACT: A Budget Amendment is needed to appropriate the $620,090.36 within EMS Fund 490. LEGAL CONSIDERATIONS: This item is approved for form and requires majority vote for approval. -JAB GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact resulting from this action. RECOMMENDATION: That the Board of County Commissioners approve EMS to accept direct payments from the program named Statewide Medicaid Managed Care (SMMC), a supplemental Medicare payment program, in the amount up to $620,090.36 and to authorize Chairman to sign seven (7) Public Emergency Medical Transportation Uniform Increase Agreements with Florida Community Care, LLC, Humana Medical Plan, Inc., Molina Healthcare of Florida, Staywell, Sunshine State Health Plan, Inc., Vivida Health and Clear Health Alliance, and to approve the necessary budget amendments. PREPARED BY: Erin Page, Accounting Supervisor, Emergency Medical Services Admin. ATTACHMENT(S) 1. MCO regions Plans by regions and MCO contacts (PDF) 2. PEMT Uniform Increase Overview (PDF) 3. [LinkedX] Letters of Agreement (PDF) 16.E.1 Packet Pg. 2395 07/14/2020 COLLIER COUNTY Board of County Commissioners Item Number: 16.E.1 Doc ID: 12538 Item Summary: Recommendation for EMS to accept direct payments from the program named Statewide Medicaid Managed Care (SMMC), a supplemental Medicare payment program, in the amount up to $620,090.36 and to authorize Chairman to sign seven (7) Public Emergency Medical Transportation Uniform Increase Agreements with Florida Community Care, LLC, Humana Medical Plan, Inc., Molina Healthcare of Florida, Staywell, Sunshine State Health Plan, Inc., Vivida Health and Clear Health Alliance, and to approve the necessary budget amendments Meeting Date: 07/14/2020 Prepared by: Title: Accounting Technician – Emergency Medical Services Name: Erin Page 06/02/2020 4:27 PM Submitted by: Title: Division Director - EMS Operations – Emergency Medical Services Name: Tabatha Butcher 06/02/2020 4:27 PM Approved By: Review: Administrative Services Department Michael Cox Level 1 Division Reviewer Completed 06/03/2020 7:53 AM Emergency Medical Services Tabatha Butcher Additional Reviewer Completed 06/11/2020 9:07 AM Administrative Services Department Len Price Level 2 Division Administrator Review Completed 06/24/2020 8:52 AM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 06/29/2020 3:57 PM Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 06/29/2020 4:36 PM Office of Management and Budget Laura Wells Additional Reviewer Completed 06/30/2020 10:24 AM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 06/30/2020 2:09 PM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 07/05/2020 7:54 PM Board of County Commissioners MaryJo Brock Meeting Pending 07/14/2020 9:00 AM 16.E.1 Packet Pg. 2396 16.E.1.b Packet Pg. 2397 Attachment: MCO regions Plans by regions and MCO contacts (12538 : Public Emergency Medical Transportation Uniform Increase STATEWIDE MEDICAID MANAGED CARE (SMMC) HEALTH PLANS (2018-2023) REGIONAL ROLLOUT SCHEDULE REGION AETNA BETTER HEALTH COMMUNITY CARE PLAN FLORIDA COMMUNITY CARE HUMANA MEDICAL PLAN LIGHTHOUSE HEALTH PLAN MIAMI CHILDREN’S MOLINA HEALTHCARE PRESTIGE SIMPLY HEALTHCARE STAYWELL SUNSHINE HEALTH UNITEDHEALTHCARE VIVIDA HEALTH PHASE 32/1/20191 FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP LIGHTHOUSE HEALTH PLAN MMA STAYWELL COMP SUNSHINE HEALTH COMP 2 FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP LIGHTHOUSE HEALTH PLAN MMA STAYWELL COMP SUNSHINE HEALTH COMP 3 FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP STAYWELL COMP SUNSHINE HEALTH COMP UNITEDHEALTHCARE COMP 4 FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP STAYWELL COMP SUNSHINE HEALTH COMP UNITEDHEALTHCARE COMP PHASE 21/1/20195 FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP SIMPLY HEALTHCARE COMP STAYWELL COMP SUNSHINE HEALTH COMP 6 AETNA BETTER HEALTH COMP FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP SIMPLY HEALTHCARE COMP STAYWELL COMP SUNSHINE HEALTH COMP UNITEDHEALTHCARE COMP 7 AETNA BETTER HEALTH COMP FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP SIMPLY HEALTHCARE COMP STAYWELL COMP SUNSHINE HEALTH COMP 8 FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP MOLINA HEALTHCARE COMP STAYWELL COMP SUNSHINE HEALTH COMP VIVIDA HEALTH MMA PHASE 112/1/20189 FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP MIAMI CHILDREN’S MMA PRESTIGE MMA STAYWELL COMP SUNSHINE HEALTH COMP 10 COMMUNITY CARE PLAN MMA FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP SIMPLY HEALTHCARE COMP SUNSHINE HEALTH COMP 11 AETNA BETTER HEALTH COMP FLORIDA COMMUNITY CARE LTC+ HUMANA MEDICAL PLAN COMP MIAMI CHILDREN’S MMA MOLINA HEALTHCARE COMP PRESTIGE MMA SIMPLY HEALTHCARE COMP STAYWELL COMP SUNSHINE HEALTH COMP UNITEDHEALTHCARE COMP Comp = Comprehensive Plan MMA = Managed Medical Assistance Plan LTC+ = Long-Term Care Plus Plan This chart includes plans who have been awarded an 2018-2023 contract, as of September 28, 2018, who will begin operation 12/1/2018 through 2/1/2019. As of 02-13-2019 16.E.1.b Packet Pg. 2398 Attachment: MCO regions Plans by regions and MCO contacts (12538 : Public Emergency Medical SMMC SPECIALTY PLANS (2018-2023) SMMC DENTAL PLANS (2018-2023) REGIONAL ROLLOUT SCHEDULE REGION CHILDREN’S MEDICAL SERVICES PLAN – CHILDREN WITH CHRONIC CONDITIONS CLEAR HEALTH ALLIANCE – HIV/AIDS MAGELLAN COMPLETE CARE – SERIOUS MENTAL ILLNESS (SMI) STAYWELL – SERIOUS MENTAL ILLNESS (SMI) SUNSHINE HEALTH – CHILD WELFARE DENTAQUEST LIBERTY MCNA DENTAL PHASE 32/1/20191 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 2 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 3 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 4 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC MAGELLAN COMPLETE CARE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN PHASE 21/1/20195 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC MAGELLAN COMPLETE CARE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 6 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 7 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC MAGELLAN COMPLETE CARE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 8 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN PHASE 112/1/20189 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 10 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN 11 CHILDREN’S MEDICAL SERVICES PLAN SPEC CLEAR HEALTH ALLIANCE SPEC STAYWELL SPEC SUNSHINE HEALTH SPEC DENTAQUEST DEN LIBERTY DEN MCNA DENTAL DEN Spec = Specialty Plan Den = Dental Plan As of 02-13-2019This chart includes plans who have been awarded an 2018-2023 contract, as of September 28, 2018, who will begin operation 12/1/2018 through 2/1/2019. 16.E.1.b Packet Pg. 2399 Attachment: MCO regions Plans by regions and MCO contacts (12538 : Public Emergency Medical SMMC Plan Contact: Provider Networks Updated 3/30/2020 Plan Name Provider Relations Contact Aetna Better Health Susan Waldman Email: FLMedicaidProviderRelations@aetna.com Phone: 1-800-441-5501 Children’s Medical Services Plan Barbara Mason Email: Barbara.Mason@wellcare.com Phone: 407-551-3238 Community Care Plan Remon Walker Email: rwalker@ccpcares.org Phone: 954-622-3308 Florida Community Care Grace Rodriguez Email: grodriguez@fcchealthplan.com Phone: 1-833-322-7526 ext.106494 Humana LTC provider contact: Ann Jamke Email: LTCProviderrelations@humana.com Phone: 561-860-8660 MMA Provider contact: Sonia Rozada Email: FLMedicaidProviderRelations@humana.com Phone: 305-626-5006 / 305-626-5266 Lighthouse Carrie Skeen Email: providerrelations@lighthousehealthplan.com Phone: 1-844-243-5181 Magellan Complete Care Dione Prinzi Sadr Email: sadrd@magellanhealth.com Phone: 407-374-5540 Miami Children’s Health Email : ProviderServices@MiamiChildrensHealthPlan.com Phone: 1-844-243-5188 Fax: 1-888-843-3938 Molina Healthcare Lisa Schwendel Email: Lisa.Schwendel@MolinaHealthCare.Com Phone: 1-866-422-2541 ext. 223594 Prestige Health Choice Lillian Morales LBMorales@prestigehealthchoice.com 561-282-4222 Simply Healthcare LTC provider contact: Renee Thomas Email: renee.thomas@amerigroup.com Phone: 954-308-9410 General LTC inquiry: ltcprovrelations@amerigroup.com MMA provider contact: Dixie Hollis Email: DHollis@simplyhealthcareplans.com Phone: 813-425-8017 Staywell Barbara Mason Email: Barbara.Mason@wellcare.com Phone: 407-551-3238 16.E.1.b Packet Pg. 2400 Attachment: MCO regions Plans by regions and MCO contacts (12538 : Public Emergency Medical Transportation Uniform Increase SMMC Plan Contact: Provider Networks Updated 3/30/2020 Sunshine Health Mark Barrett Email: sunshinecontracting@centene.com Phone: 1-866-595-8116 United Healthcare Felix Gonzalez Email: felix_m_gonzalez@uhc.com Phone: 407-659-6965 Vivida Health Stacey Lau Email: providerrelations@vividahealth.com Phone: 1-844-243-5175 DENTAL Plan Name Provider Relations Contact DentaQuest Vanessa Guerrero Email: FloridaProviders@DentaQuest.com Phone: 1-877-468-5581 LIBERTY Betty Gilbert Email: prinquiries@libertydentalplan.com Phone: 1-888-352-7924 ext. 393 MCNA Mercedes Linares Email: prdepartment@mcna.net Phone: 1-855-698-6262 16.E.1.b Packet Pg. 2401 Attachment: MCO regions Plans by regions and MCO contacts (12538 : Public Emergency Medical Transportation Uniform Increase Florida Division of Medicaid AHCA – MPF April 14, 2020 Public Emergency Medical Transportation Uniform Increase Background: In the 2019 General Appropriations Act, the Florida Legislature directed the Agency for Health Care Administration (Agency) to make direct payments to qualifying Public Emergency Medical Transportation (PEMT) providers for services under the Statewide Medicaid Managed Care (SMMC) program. The Agency submitted the 438.6(c) Pre-print uniform increase proposal to the Centers for Medicare and Medicaid Services (CMS) on August 30, 2019, and received approval from CMS April 8, 2020. This payment will be similar to the existing unform increases for the Medical Schools and Cancer Hospitals. Qualifying Providers: The PEMT program provides supplemental payments to eligible public entities that meet specific requirements and provide emergency medical transportation to Medicaid recipients. Please see the attached exhibit for a list of qualified providers and their contact information for state fiscal year 2019-20. Distribution: The direct payment must be made through a uniform increase calculated as a supplemental per member per month. This amount will be calculated from actuarially sound projections of supplemental support for PEMT providers under the State’s fee-for-service program as well as projections for the current year’s managed care population based on historical utilization. These funds will be available to the SMMC health plans to distribute quarterly to qualified PEMT providers. The State will provide the SMMC health plans with each participating PEMT provider’s allocation of the aggregate projected payment amount. Each PEMT provider will receive their estimated allocation during the course of the year if the actual utilization is met within a maximum of +1% and a minimum of -5% of the projected utilization. The threshold reconciliation will be performed by the Agency annually. If the utilization exceeds 1% above the projected threshold, the SMMC health plans must continue to make payments at the originally contracted rates. If the utilization falls more than 5% below the projected threshold, the PEMT provider must return the uniform increase payment amounts above the contracted rate to the Agency. Next Steps: The SMMC health plans are required to have an agreement in place with the PEMT providers in their corresponding regions before payments are disbursed. The Agency will also amend the SMMC health plans’ contracts to include the new uniform increase. An example agreement is attached as an exhibit. This agreement is acceptable, but is not the only agreement that may be used for these purposes. 16.E.1.c Packet Pg. 2402 Attachment: PEMT Uniform Increase Overview (12538 : Public Emergency Medical Transportation Uniform Increase Agreements) Letter 01 Agreement This Letter' of Agreement ("LOA"} is made and entered into on the 1st of May, 2020 by and between Collier Coun y EMS (Government Owned Emergency Medical Service (EMS) Provider) and WellCare of Florida, Inc. d/b/a Staywell, a managed care organization operating the Statewide Medicaid Managed Care plan and the Children's Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as "Parties"). WHEREAS, the Medicaid MCO has been awarded a 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 8 ,which includes Charlotte,, Collier, Desoto, Glades, Hendt'y, Ue and Sarasota County where Government Owned EMS Provider is located and/or operates; WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying entity and provldes out of network emergency medical services to MCO enrollees in Region 8 on an as needed basis, when the transport and treatment is appropriate; and WHEREAS, the Centers foi• Medicare and Medicaid Services ("CMS"} approved section 438.E directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicaid eligible persons enrolled in managed cair, 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 eixiergency medical services available to MCO's Medicaid enrollees on an as needed basis, when the transport and treatment is appropriate, 2, Medicaid MCO shall receive per member per month section 438.E directed payments for care and treatment provided by the Government Owned EMS Provider, Which the Medicaid MCO sha11 timely remit to the Government Owned EMS Provider in accordance with AHCA's contractual requirements, 3. Contact information for the parties is as follows: Name: Tabatha Butcher Title: Chief EMS Phone* 239-252-3780 Email: Tabatha.Buficher �r colliei•countyfl.gov Name: Janette White Title: Sr. Manager Phone: 813-532"7332 Email: Janette. white ct Wellcare.coin 4. The Parties agree any modification to the LOA shall be in the same form, namely the exchange of signed copies of a revised LOA. S. This LOA covers the period of October 1, 2019 through June 30, 2024 unless terminated sooner by the termination of section 438.d directed payments. IN WITNESS WHEREOF, the Parties have duly executed this LOA on the day and written. Each party represents that; (i) it has the authority to enter into this Agreement; individual signing this Agreement on its behalf is authorized to do so. GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER Burt L. Saunders, Chairman NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL 7/ 14/2020 DATE MEDICAID MANAGED CARE ORGANIZATION Mark J. Fehring, VP Field Network Management NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL DATE ATTEST CRYSTAL K, KIN7,EL, CLERK BY; Approved As to form anti Ir�.ility yeas above first and (ii) that the Assistaijt County Atturncy .�'dw CA CAO better of Agreement This I..etter of Agreement {"LOA") is made and entered into on the 1 st day of May, 2020 by a110 between Collier County Emergency Medical Services (Government Owned Emergency Medicl Service (EMS} Provider} anssurai�Ce d Best Care A,, LLC dll,/a Viyida1ealth CA (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as "Parties"). WHEREAS, the Medicaid MCO has been awarded a contract by the Agency for Health ,are Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 115 Managed Medical Assistance Waiver (the "Waiver") in Region .8_, which includes Charlotte, Collier, Desoto, Glades, Hendrv, Lee and Sarasota County where Government Owned EMS Provider is located andlor operates; WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 8 on an as needed basis, when the transport and treatment is appropriate; and WHEREAS, the Centers far Medicare and Medicaid Services {"CMS"} approved section 438.6 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers 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 tnalce emergency medical services available to MCO's Medicaid enrollees on an as needed basis, when the transport and treatment is appropriate, 2, Medicaid MCO shall receive per member per month section 438.E 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. 3. Contact information for the parties is as follows: Name: Tabatha Butcher Title: Chief EMS Phone :239-ZS2-378Q Email: Tabatha.Butcher tr CollierCountyFl.gov Name; I{evin 1�. Dotson, FSA, MAAA Title: Chief Financial Officer Phone:239-343-1316 Email: Kenvin.dotson r�leehealth.org 4. The Patties agree any modification to the LOA shall be in the same form, namely the exchange of signed copies of a revised LOA. 5. This LOA covets the period of October 1, 2019 through June 30, 2024 unless terminated sooner by the termination of section 438.6 directed payments. IN WITNESS WHEREOF, the Patties 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 signing this Agreement on its behalf is authorized to do so. GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER Butt L. Saunders, Chairman NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL 7/ 14/2020 DATE MEDICAID MANAGED CARE ORGANIZATION NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL DATE ATTEST CRYSTAL IC. KINZEL, CLERIC BY: Approved as to form anti I�gality O Assistant County Attc>rury � �a\a lob C'�O Letter of Agreement This Letter of Agreement ("LOA") is made and entered into on the 1 st of May, 2020 by and between Collier County EMS (Government Owned Emergency Medical Service (EMS) Provider) and Sunshine State Health Plan, Inc., a managed care organization operating the Statewide Medicaid Managed Care plan and if applicable, the Children's Medical Services plan (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as "Parties"). WI-IEREAS, the Medicaid MCO has been awarded a 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 8, which includes Charlotte, Collier, Desoto, Glades, sawsHendry, Lee and Sarasota County where Government Owned EMS Provider is located and/or operates; WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 8 on an as needed basis, when the transport and treatment is appropriate; and WHEREAS, the Centers for Medicare and Medicaid Services {"CMS"} approved section 438.6 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers for the provision of emergency medical services to Medicald eligible persons enrolled in managed care organizations pursuant to the Waiver, which includes the Medicaid MCO. NOW THEREFORE, Gavernmetlt 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 is appropriate. 2, Medicaid MCO shall receive per member per month section 438.E directed payments for care and treatment provided by the Government Owned EMS Provider, which the Medicaid MCO shall fiimely remit to the Government Owned EMS Provider in accordance with AHCA's contractual requirements. 3. Contact information for the parties is as follows: Name: Tabatha Butcher Title: Chief of EMS Phone: 239-252-3780 Email: Tabatha.Butche,tQ(coiiiercouiityfl.,�ov , To Health Plan at: Attn: President I CEO Sunshine State Health Plan, Inc. 1301 International Parkway, 4tE' floor Sunrise, FL 33323 4, The Parties agree any modification to the 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, 2017 through June 305 2024 unless ter'r111tlated sooner by the termination of section 438.6 directed payments. IN WI"I'NESS 1lVHEREOF, the Patties have duly execLited this LOA on the day atld year• above first written. Each party represents that: (1) it has the authority to enter into this Agreement; and that the individual signing this Agreement on its behalf is authorized to do so. GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER Butt L. Saunders, Chairman NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL 7/14/2020 DATE MEDICAID MANAGED CARE ORGANIZATION Elizabeth M. Miller, President /CEO NAME & TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL DATE ATTEST CRYSTAL K. KINZEL, CLERIC BY: Approved �s to form and Irhulity Assistant County Attoniwy 5Y- X.eUVI of Agreerne"t This Letter of Agreement ("LOA") is made and entered into ozl the 15` day of May,by and between Collier County EIVIS (Government Owned Emergency Medical Service (EMS} Provider) and SIMPLY HEALTHCARE PLANS, INC. DBA CLEAR HEALTH ALLIANCE (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as "Parties"). WHEREAS, the Medicaid MCO leas been awarded a contract by the Agency for Health .are Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 11 1 S Managed Medical Assistance Waiver (the "Waiver") in Region 8 which includes Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota County where Government Owned EMS Provider is located and/or operates; WHEREAS, AHCA leas approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 8 oil an as needed basis, when the transport and treatment is appropriate; and WHEREAS, the Center's fog• Medicare and Medicaid Services ("CMS") approved section 438.6 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers 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 matte emergency medical services available to MCO's Medicaid enrollees on an as needed basis, when the transport and treatment is 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. 3. Contact information for the parties is as follows: Name: Tabatha Butcher Title: Chief EMS Phone: 239-252-378� Email: "Tabatha.Butcher@CollierCountyFL.gov Name: Barbara Morales Title: Provider Network Manager Phone: 950405-6136 Email: bmorales t�simplyhealthcareplans.com 4. The Parties agree any modification to the 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. IN WITNESS WHEREOF, the Parties have duly executed this LOA on the day and year above first written. Each patty represents t11at: (i) it has the authority to enter into this Agreement; and (ii) that the individual signing this Agreement on its behalf is authorized to do so. GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER Burt L. Saunders, Chait•man NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL 7/ 14/2020 DATE MEDICAID MANAGED CARE ORGANIZATION NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL DATE ATTEST CRYSTAL K. KINZEL, CLERK F3Y: Approved as to farm and legality O Assistutit County Atttirnry � ,���� 9- aa• Letter of AAVgreement This Letter of Agreement ("LOA"} is made and entered into on the Xs# of NtaY, 220 by and between Collier County EMS (Government Owned Emergency Medical Service (EMS) Provider) and Molina Healthcare of Florida (Medicaid Managed Care Organization (MCO) (herein referred to collectively as "Parties"), WHEREAS, the Medicaid MCO has been awarded a contract by the Agency for Health Care Administration (APICA) to deliver managed care services to Medicaid enrollees under an i l l S Managed Medical Assistance Waiver (the "Waiver") in Region 8 , which includes Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota County where Government Owned EMS Provider is located and/or operates; WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 8 on an as needed basis, when the transport and treatment is appropriate; and WHEREAS, the Centers for Medicare and Medicaid Services ("CMS"} approved section 438.6 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers 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 is appropriate. 2. Medicaid MCC) shall receive per member per month section 438.E directed payments for care and treatment provided by the Government Owned EMS Provider, which the Medicaid MCC} shall timely remit to the Government Owned EMS Provider in accordance with AHCA's contractual requirements. 3. Contact information for the parties is as follows: Name: Tabatha Butcher Title: Chief EMS Phone: 239-252-378� Name: Carol Andrews Title: Contract Manager Phone: (813) 394-6750 Tabatha.Butcher Lcoiliercountyfl.gov Carol,Andrews�Molinahealthcare.com 4. The Parties agree any modification to the LOA shall be in the same form, namely the exchange of signed copies of a revised LOA. 5. This LOA covers the period %J October 1, 2019 through June 3U, 2024 unless terminated sooner by the termination of section 438.6 directed payments. IN WITNESS WHEREOF, the Parties have duly executed this LOA on the day and year above first written. Each party represents that; (1) it has the authority to enter into this Agreement; and (ii) that the individual signing this Agreement on its behalf is authorized to do so. GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER Burt L. Saunders, Chairman NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL 7/ I �/2020 DATE MEDICAID MANAGED CARE ORGANIZATION Gregory Lipson, VP Network Management - NAME & TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL DATE ATTEST CRYSTAL K. KINZEL, CLERI{ gY: Alrprovcd as to farm and Icgality �C7 em; Assistant County Attorney �e �- U Public Emergency Medical Transportation UnHui •m Incx•ease Agreement This Public Emergency Medical TLansportation Uniform Increase Agreement ("PEMTUTA") is made and entered into on the 1st day of May, 2020 by and between Collier County EMS(Government Owned Emergency Medical Service (EMS) Provider) and Humana Medical Plan, Inc. (Medicaid Managed Care Organization (MCO)) (herein referred to collectively as "Parties"). WHEREAS, the Medicaid MCO has been awat•ded a contract by the Agency for Health Care Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 115 Managed Medical Assistance Waiver (the "Waiver") in Region 8, which includes Cliarlotte, Collier, Desoto, Glades, Hendi4y, Lee and Sarasota County where Government Owned EMS Provider is located and/or operates; WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 8 on an as needed basis, when the transport and treatment is appropriate, and WHEREAS, the Centers for Medicare and Medicaid Services ("CMS") approved section 438.6 directed payments based on the establishment of a uniformincrease to be paid to qualifying Government Owned EMS Providers 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, Govertultent 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 is appropriate. 2. Medicaid MCO shall receive per member per month section 438.E directed payments for care and treatment p►•ovided by the Government Owned EMS P►•ovidet•, which the Medicaid MCO shall timely remit to the Government Owned EMS Provider in accordance with AHCA's contractual requirements. 3. Contact information for the patties is as follows; Natne: Tabatha Butcher Title: Chief EMS Name: Ann ,iamke Title: Director Provider Contracting Phone: 239-252-3780 Phone: (904) 3164899 Email: Tabatha.Butcher@CollierCountyFL.gov Email ajatiike@humana.com 4. The Parties agree any modification to the Public Emergency Medical Transportation Uniform increase agreement shall be in the same form, namely the exchange of signed copies of a revised Public Emergency Medical Transportation Uniform Increase Agreement. 5. This Public Emergency Medical Transportation Uniform Increase Agrge►nent covers the pet'iod of October 1, 2019 through June 30, 2024 unless terminated sooner by the termination of section 438.6 directed payments. IN WITNESS WHEREOF, the Parties have duly executed tllis Public Emergency Medical T►•ansportation Uniform Increase Agreement on the day and year above first written. Each party ►epresents that; (i) it has the authority to enter into this Agreement; and (ii) that the individual signing this Agreement on its behalf is authorized to do so. GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER Burt L. Saunders, Chairman NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL 7/ 14/2020 DATE MEDICAID MANAGED CARE ORGANIZATION Ann Jamlce, Directot• Provider Contracting NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE CYF AUTHORIZED INDIVIDUAL 05/12/2020 DATE ATTEST CRYSTAL K. KINZEL, CL1rRIC I3Y: Apl�ravcd As to form anal legality ,�� Assistant County Attorney C Letter• of Agreement This Letter of Agreement ("LOA") is made and entered into on the 1st day of May, 2020 by and between Collier County EMS (Government Owned Emergency Medical Service (EMS) Provider) and Floi•ida Community Care, LLC (Medicaid Managed Care Organization (MCO) (herein referred to collectively as "Parties"). WHEREAS, the Medicaid MCO has been awarded a contract by the Agency for Health .are Administration (AHCA) to deliver managed care services to Medicaid enrollees under an 1 115 Managed Medical Assistance Waiver (the "Waiver") in Region 8, which includes Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota County where Government Owned EMS Provider is located and/or operates; WHEREAS, AHCA has approved the Government Owned EMS Provider as a qualifying entity and provides out of network emergency medical services to MCO enrollees in Region 8 on an as needed basis, when the transport and treatment is appropriate; and WHEREAS, the Centers for Medicare and Medicaid Services ("CMS") approved section �38.6 directed payments based on the establishment of a uniform increase to be paid to qualifying Government Owned EMS Providers 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 is 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. 3. Contact information for the parties is as follows: Name: Eric Tatum Name: Title: Director of Provider Services Title: Phone: 786� 778-6825 Phone: C-mail: etatum�fcchealthplan.com E-►nail: Page r oF2 `Tabatha Butcher Chief EMS 239-252-3780 tabatha.butcherAcol liercountyfl.gov The Parties agree any modification to the LOA shall be in the same form, namely the exchange of signed copies of a revised LOA. 4. 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. IN WITNESS WHEREOF, the Parties leave dilly executed this LOA Qn the day and year above first written. Each party represents that: (1) it has the authority to enter into this Agreement, and (ii) that the individual signing this Agreement on its behalf is authorized to do so. GOVERNMENT OWNED EMERGENCY MEDICAL SERVICES PROVIDER Bllrt L. Saunders, Chairman NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AtTHORIZED INDIVIDUAL 7/ 14/2020 DATE MEDICAID MANAGED CARE ORGANIZATION Nestor Plana, Chief Executive Officer NAME &TITLE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL DATE ATTEST CRYSTAL K. KINZEL, CLERK 13Y: Page 2 of2 Approved as to tbrm anc! legality Wl Assistant County Attmney COP �a tQ