03-04-19 Personnel and Finance (Tax Caps/Impact)

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CITY OF SOUTH BEND I OFFICE OF THE CLERK Now Councilmember Scott stated, Thank you. Mr. Parker went on, Like I said, this is probably the most significant issue that we are facing from a revenue perspective but it's not the only one(1). As I mentioned, I did want to talk briefly as this could be another two (2) hour discussion on this issue about the Medicaid Supplemental Payment Adjustment. This is a program that our Fire EMS participates in and the essentials of the program are that the State and the Federal Government recognizes that the Medicaid reimbursements that we receive from our ambulance runs aren't covering the costs to provide them. What the State and Federal Government do is they assess our actual cost of providing those services and give us a supplemental payment to cover the difference between what they reimbursed us and our actual cost. Historically, as this graph shows, this supplemental payment was north of a million dollars. One(1)year it was up around$1.8 million back in 2014, over the past three(3) years this has been around $400,000-$500,000. So, there is a pretty significant decrease in the amount that we have been receiving for the program. The causes for this are again not getting too deep into it, there are two (2) basic ways that Medicaid recipients participate in Medicaid. It's either through traditional Medicaid in which the State directly pays for their claims or through what is called Managed Care Medicaid in which the State pays a third (3rd) party insurance company. The Managed Care Medicaid, we do not receive this supplement payment that is covered by Managed Care Medicaid. We only receive this supplemental payment from patients covered by traditional Medicaid. As more and more patients move from traditional Medicaid to Managed Care Medicaid,this payment is expected to continue to decrease. That is actually a targeted intentional move by the State to move more patients to Managed Care Medicaid because it's less expensive for the State. There is an argument out there that it improves quality for the patient and other types of things. Committeemember Jo M. Broden asked, You said the difference in the cost for us to make those runs, is there any tweaking on the cost side on our side? Mr. Parker answered, We actually put together a cost report. We contract with a consultant from Blue In Company to help us do that. It's fairly formulaic and it's Medicare driven. You have to be very careful and track your cost for how much it actually costs to run the ambulance service. There's not much tweaking we can do in it, which is intentional because they don't want people to ramp up costs so that they get more reimbursement money. Committeemember Broden asked, Is that in terms of who actually serves on that call? Is that also pretty standardized to actually get to a qualified level of reimbursement? Do you see what I am asking? Mr. Parker clarified, In terms of who actually goes to the patient? I do know that the Fire Department is working very hard on changing their staffing model and the goal there is to reduce the cost,put only the people who need to be on the scene,on the scene unless a higher-level person, say, a lead paramedic is needed,then they can use J-Star. I don't know if that is specifically driven by this, but it is an effort to reduce cost in response to lowering the reimbursement. Councilmember Oliver Davis asked, Along those same lines, do you route the change in terms of the people traveling to be rushed to Saint Joseph Hospital versus Memorial Hospital which has added more time and distance to driving to Saint Joseph Hospital out in Mishawaka? Do we even take people out of State lines? Does that make sense? EXCELLENCE I ACCOUNTABILITY I INNOVATION I INCLUSION I EMPOWERMENT 455 County-City Building 227W.Jefferson Bvld South Bend,Indiana 46601 p 574.235.9221 f574.235.9173 j TTD574.235.55671www.southbendin.gov 5