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Ordinance authorizing the City of Pittsburgh (“City”) to enter into an Intergovernmental Cooperation Agreement or Agreements with the Commonwealth of Pennsylvania, Department of Human Services (“DHS”) with regard to Medicaid reimbursement services, for a term of one year plus two possible one-year extensions at the parties’ mutual option. The Agreement(s) shall result in net revenue for the City but will require upfront expenses in an amount not to exceed Four Million Seven Hundred Thousand Dollars ($4,700,000) annually, for a total amount not to exceed Fourteen Million One Hundred Thousand Dollars ($14,100,000).
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WHEREAS, DHS is the single state agency responsible to administer the Medicaid Program in Pennsylvania, which is known as the Pennsylvania Medical Assistance (“MA”) Program;
WHEREAS, the City operates a Department of Public Safety, Bureau of Emergency Medical Services, (“City EMS”) that participates as a provider in the MA Program;
WHEREAS, the City EMS provides essential emergency medical services and serves as a vital safety net for numerous MA beneficiaries and other Pittsburgh residents;
WHEREAS, the City EMS incurs substantial costs to provide emergency medical services to MA beneficiaries; and,
WHEREAS, DHS intends to seek the approval from the Centers for Medicare and Medicaid Services (“CMS”) to increase Pennsylvania Medicaid’s minimum ground ambulance transportation fee (“Fee Schedule”) for city-owned and operated EMS providers; and
WHEREAS, said Agreement(s) allow the City and its billing contractor to charge higher rates under the MA Program and can be expected to net significant revenue for the City; and
WHEREAS, said Agreement(s) will require upfront encumbrances as set forth below in order to reimburse DHS on a quarterly basis as required by the MA Program.
The Council of the City of Pittsburgh hereby enacts as follows:
SECTION 1 - CONDITIONS OF AGREEMENT
The Mayor and the Director of Public Safety are hereby authorized to enter into an intergovernmental Cooperation Agreement or Agreements with the Commonwealth of Pennsylvania, Department of Human Services, for Medicaid reimbursement services pursuant to the General Local Government Code, 53 Pa. C.S. §§2301 et seq., 62 P.S. §101, 42 U.S.C. §1302 and 42 CFR §433.51, as implemented through Pennsylvania’s Medical Assistance (“MA”) Program managed care delivery system.
SECTION 2 - DURATION OF AGREEMENT
Said Agreement(s) shall be for a term of one year, with two mutual one-year options, commencing on January 1, 2026.
SECTION 3 - PURPOSE AND OBJECTIVES
The purpose of said Agreement(s) is to generate significant net revenues for the City and to ensure additional funds are available to enable it to maintain continued access to emergency medical services for Medicaid managed care participants in the City.
SECTION 4 - FINANCING
Pursuant to 53 P.S. §2307(4), and in consideration of the services that must be financed pursuant to this Agreement, the City shall pay DHS an amount on a quarterly basis per the schedule attached to the parties’ Intergovernmental Cooperation Agreement. The costs to be reimbursed by the City to DHS shall be in an amount not to exceed Four Million Seven Hundred Thousand Dollars ($4,700,000) annually, for a total amount not to exceed Fourteen Million One Hundred Thousand Dollars ($14,100,000), subject to annual appropriation by City Council in future budget years. Expenditures will be made from the following JDE Accounts:
11101.220000.58.58101.2026
11101.220000.58.58101.2027
11101.220000.58.58101.2028
TOTAL NOT TO EXCEED: $14,100,000
SECTION 5 - ORGANIZATIONAL STRUCTURE
Services provided by the City as authorized hereunder are organized under its Department of Public Safety, Bureau of Emergency Medical Services.
SECTION 6 - REAL/PERSONAL PROPERTY
All property involved in the performance of said Agreement(s) is owned by the City of Pittsburgh.
SECTION 7 - GROUP INSURANCE/EMPLOYEE BENEFITS
Pursuant to 53 P.S. §2307(7), to the extent that any is entity created hereunder it shall be empowered to enter into contracts for policies of group insurance and employee benefits, including Social Security, for its employees.
SECTION 8 - MISCELLANEOUS
All resolutions and ordinances or portions thereof that are inconsistent herewith are hereby repealed to the extent of such inconsistency.
Said Intergovernmental Cooperation Agreement(s) shall be in a form approved by the City Solicitor.