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1 <br /> ORANGE COUNTY <br /> BOARD OF COMMISSIONERS <br /> ACTION AGENDA ITEM ABSTRACT <br /> Meeting Date: June 15, 2021 <br /> Action Agenda <br /> Item No. 8-r <br /> SUBJECT: Medicaid Transformation - Public Ambulance Providers (PAPs) Contracts with <br /> Public Healthcare Providers (PHPs)/Managed Care Organizations (MCOs) <br /> DEPARTMENT: Emergency Services <br /> ATTACHMENT(S): INFORMATION CONTACT: <br /> DHB Managed Care PHP Ambulance Kirby Saunders, 919-245-6123 <br /> Provider Fee Schedule Kim Woodward, 919-245-6133 <br /> NC Medicaid Clinical Coverage Policy 15- <br /> Ambulance Services <br /> North Carolina's Transformation to <br /> Medicaid Managed Care Fact Sheet <br /> PURPOSE: To approve entering into agreements with the five (5) Managed Health Care <br /> Organizations in order to be eligible for direct payments for Medicaid transports by Orange County <br /> Emergency Medical Services (EMS). <br /> BACKGROUND: The NC Department of Health and Human Services (DHHS) will transition most <br /> beneficiaries to NC Medicaid Managed Care statewide on July 1, 2021. In order to be eligible, <br /> the County must enter into agreements by July 1, 2021 with the five (5) Managed Health Care <br /> Organizations for direct payments for Medicaid transports by EMS. <br /> North Carolina has proposed a qualified directed payment to Public Ambulance Providers (PAPs) <br /> to approximate the costs of covered services which PAPs incur in serving Medicaid and NC Health <br /> Choice beneficiaries. Enabling state legislation, Session Law 2015-245 <br /> https://www.ncleg.gov/enacted leg islation/sessionlaws/htm1/2015-2016/s12015-245.htm1, <br /> requires PAPs to become in-network providers with each of the Public Healthcare Providers <br /> (PHPs)/Managed Care Organizations (MCOs) companies. Failing to contract with each individual <br /> provider may result in significant loss of revenue for Orange County as compared to existing and <br /> proposed Medicaid fee schedules. As such, Orange County Emergency Services is required by <br /> state legislation to contract with each of the five (5) MCOs (AmeriHealth Caritas, Blue Cross NC, <br /> Carolina Complete Health, United Health, and WellCare) before July 1, 2021. <br /> The state has established cost-based rates for each Public Ambulance Provider that determined <br /> a minimum fee schedule that will serve as a rate floor (fee schedule) in managed care. The rates <br /> are subject to approval by the Center for Medicare and Medicaid Services. The draft rate schedule <br /> and the Public Ambulance Provider Addendum are provided as attachments. The Public <br /> Ambulance Provider Addendum has been included in each of the contracts. Based on the <br />