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Agenda - 06-15-2021; 8-r - Medicaid Transformation - Public Ambulance Providers (PAPs) Contracts with Public Healthcare Providers (PHPs)-Managed Care Organizations (MCOs)
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Agenda - 06-15-2021; 8-r - Medicaid Transformation - Public Ambulance Providers (PAPs) Contracts with Public Healthcare Providers (PHPs)-Managed Care Organizations (MCOs)
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6/10/2021 4:42:02 PM
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6/15/2021
Meeting Type
Business
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Agenda
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8-r
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Agenda for June 15, 2021 Board Meeting
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2 <br /> proposed fee schedule and the County's payor mix, staff is anticipating a positive impact on <br /> revenue. Additionally, there may be the potential for additional revenue sources associated with <br /> expanded program in the future. <br /> NC EMS providers will be expected to contract with the PHPs in order to receive payment for <br /> services provided to these Medicaid recipients. Claims will be filed to the PHP for eligible Medicaid <br /> recipients rather than directly to NC Medicaid. Infocrossing, LLC has been named the Provider <br /> Data Contractor, whose responsibilities will include credentialing of Medicaid-enrolled providers <br /> and sharing the information with the PHPs. The goal of the Provider Data Contractor will ensure <br /> a consistent process of enrollment. Under the managed care program, the Department will <br /> mandate that the PHP maintain a certain level of payment by establishing a rate floor, or minimum <br /> payment of 100% of the Medicaid fee for-service rates <br /> Orange County Emergency Services has been meeting with the North Carolina Department of <br /> Health and Human Services (NCDHHS), PHPs/MCOs, and other PAPs for approximately 18 <br /> months to determine the contract processes. The new rate is expected to go live on July 1, 2021 . <br /> The Orange County floor rate is $1,067.92 as identified in the latest rate schedule provided by <br /> NCDHHS on March 31, 2021. This source accounts for approximately 27% of EMS fees, or <br /> roughly $700,000 a year in revenue for Orange County. The contracts are being finalized and <br /> may be modified before the July 1, 2021 deadline. Any substantial new information as determined <br /> by the County Attorney will be provided to the BOCC. <br /> Staff requests that the Board approve entering into contracts with Public Healthcare Providers <br /> (PHPs)/Managed Care Organizations (MCOs)for Orange County Emergency Services to become <br /> an in-network provider for their members/covered persons and authorize the County Manager to <br /> execute the contracts and any addendum to the contracts. <br /> FINANCIAL IMPACT: Staff projects $700,000 in expected revenue for Orange County. <br /> SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goal impact is <br /> applicable to this item: <br /> • GOAL: CREATE A SAFE COMMUNITY <br /> The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang <br /> activity, substance abuse and domestic violence. <br /> ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal <br /> impact associated with this item. <br /> RECOMMENDATION(S): The Manager recommends that the Board approve entering into the <br /> five (5) contracts with the identified MCOs and authorize the County Manager to execute the <br /> contracts and addendums. <br />
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