HomeMy WebLinkAboutCC Resolution 14322 (Ambulance Service Cost Recovery)RESOLUTION NO. 14322
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AUTHORIZING THE
CITY MANAGER TO EXECUTE AGREEMENTS TO ALLOW THE SAN RAFAEL FIRE
DEPARTMENT TO PARTICIPATE IN AN INTERGOVERNMENTAL TRANSFER WITH THE
CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (DHCS) IN ORDER TO
INCREASE THE DEPARTMENT'S REIMBURSEMENT FOR EMS AMBULANCE
TRANSPORT SERVICES PROVIDED TO COUNTY HEALTH PLAN (PARTNERSHIP
HEALTH PLAN) MEMBERS FOR FY 2015-2016 and FY 2016-2017.
WHEREAS, the City of San Rafael, through its Fire Department, regularly provides emergency
ambulance transport to persons who are Medi -Cal patients enrolled in managed care plans; and
WHEREAS, the City participates in various governmental programs that provide reimbursement
of costs incurred in providing such emergency services to Medi -Cal patients; and
WHEREAS, pursuant to the authority of Welfare & Institutions Code sections 14164 and
14301.4, since 2006 the California Department of Health Care Services (DHCS) has been
offering a voluntary rate range Intergovernmental Transfer Program to allow healthcare
providers such as the City of San Rafael Fire Department to access federal matching funds for
reimbursement through their Medi -Cal Managed Care Health Plan Providers; and
WHEREAS, the City may pursue an Intergovernmental Transfer to DHCS through its Medi -Cal
Managed Care Health Plan Provider, Partnership Health Plan of California (PHC); and
WHEREAS, by participating in the Intergovernmental Transfer Program, the City will receive
reimbursements for a larger proportion of its actual costs for providing emergency ambulance
transport to Medi -Cal patients enrolled in managed care plans; and
WHEREAS, under the Intergovernmental Transfer Program, the funds shall be transferred in
accordance with a mutually agreed upon schedule between the City of San Rafael and DHCS.
NOW, THEREFORE, BE IT RESOLVED, that the City Council does hereby authorize the San
Rafael Fire Department to participate in an Intergovernmental Transfer (IGT) with the California
Department of Health Care Services (DHCS) in order to increase the Department's
reimbursement for EMS ambulance transport services provided to Partnership Health Plan of
California members for FY 2015-2016 and FY 2016-2017.
BE IT FURTHER RESOLVED, that the City Council hereby authorizes the City Manager to
execute agreements with PHC and DHCS for the San Rafael Fire Department's participation in
this program, subject to final approval as to form by the City Attorney.
BE IT FURTHER RESOLVED, that the City Council does hereby authorize the transfer of funds
to DHCS pursuant to such agreements, in an amount approved by the City Manager and in
accordance with a mutually agreed upon schedule, to be used solely as a portion of the non-
federal share of actuarially sound Medi -Cal managed care capitation rate increases for the
Partnership Health Care period of June 30, 2015 through July 1, 2016 and June 30, 2016
through July 1, 2017.
I, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the foregoing
Resolution was duly and regularly introduced and adopted at a regular meeting of the City
Council of said City held on Monday, the 15th day of May, 2017, by the following vote, to wit:
AYES: COUNCILMEMBERS: Bushey, Colin, Gamblin, McCullough & Mayor Phillips
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
ESTHER C. BEIRNE, City Clerk
Partnership HealthPlan of California
DRAFT CONTRIBUTION ALLOCATION ESTIMATES IN THE ORIGINAL HEALTH PLAN REGION - FY 2015/16
7
Column B Column C
Column D
Column E
Column G
Column H
Column I
Column J
$208,289
Costs for
Revenues
2015-16
Transfer to
DHCS Admin
PHC's payment
Net new funds
3
Partnership
from PHC
Unreimb.
fund the IGT
Fee
to provider
in PHC's
3
Services
Costs
20% of
total funds
payment to
Column G
Provider
4
MARIN headroom: $4,091,940
Max provider contribution:
$2,001,115
5
Marin Cnty HHS & Cnty Fire $2,479,862
$102,992
$2,376,870
$652,865
$130,573
$1,334,997
$551,560
6
Novato Fire $425,997
$44,360
$381,637
$104,826
$20,965
$214,351
$88,560
7
San Rafael Fire
$956,665
$59,071
$897,594
$246,546
$49,309
$504,144
$208,289
8 Southern Marin Fire $582,883 $23,196 $559,687 $153,732 $30,746 $314,355 $129,877
charge based
9 Marin General Hospital $3,069,627 $0 $3,069,627 $843,147 $168,629 $1,724,093 $712,316
10
Subtotal
$7,515,034
$229,619
$7,285,415
$2,001,115
$400,223
$4,091,940
$1,690,602
Partnership HealthPlan of California
DRAFT CONTRIBUTION ALLOCATION ESTIMATES IN THE ORIGINAL HEALTH PLAN REGION - FY 16/17
Column B
Column C
Column D
Column E
Column G
Column H
Column I
Column J
Costs for
Revenues
2015-16
Transfer to
DHCS Admin
PHC's payment
Net new funds
3
Partnership
from PHC
Unreimb.
fund the IGT
Fee
to provider
in PHC's
3
Services
Costs
20% of
total funds
payment to
o
Column G
Provider
4
MARIN headroom: $5,093,063
Max provider contribution:
$2,446,812
5
Marin Cnty HHS & Cnty Fire
$2,479,862
$102,992
$2,376,870
$798,274
$159,655
$1,661,614
$703,686
6
Novato Fire
$425,997
$44,360
$381,637
$128,173
$25,635
$266,794
$112,986
San Rafael Fire
$956,665
$59,071
$897,594
$301,458
$60,292
$627,487
$265,738
Southern Marin Fire
$582,883
$23,196
$559,687
$187,971
$37,594
$391,264
$165,698
charge based
Marin General Hospital
$3,069,627
$0
$3,069,627
$1,030,936
$206,187
$2,145,904
$908,781
10
Subtotal
$7,515,034
$229,619
$7,285,415
$2,446,812
$489,362
$5,093,063
$2,156,889
CONTRACT # 16-93710
INTERGOVERNMENTAL TRANSFER ASSESSMENT FEE
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF HEALTH CARE
SERVICES ("State DHCS") and the City of San Rafael (GOVERNMENTAL FUNDING ENTITY) with
respect to the matters set forth below.
RECITALS
A. This Agreement is made pursuant to the authority of Welfare & Institutions Code, section
14301.4.
THEREFORE, the parties agree as follows:
AGREEMENT
1. Transfer of Public Funds
1.1 GOVERNMENTAL FUNDING ENTITY shall make Intergovernmental
Transfer(s) ("IGTs") to State DHCS pursuant to section 14164 of the Welfare and Institutions Code and
paragraph 1.1 of the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds contract
number 16-93679, to be used as a portion of the non-federal share of actuarially sound Medi -Cal managed
care rate range capitation increases ("non-federal share IGT") to HEALTH PLAN (Partnership
HealthPlan of California) for the periods of July 1, 2015 to June 30, 2016 and July 1, 2016 to June 30,
2017.
1.2 The parties acknowledge that State DHCS will obtain any necessary approvals
from the Centers for Medicare and Medicaid Services ("CMS") pertaining to the acceptance of non-
federal share IGTs and the payment of non-federal share IGT related rate range capitation increases to
HEALTH PLAN.
2. Intergovernmental Transfer Assessment Fee
CONTRACT # 16-93710
2.1 The State DHCS shall, upon acceptance of non-federal share IGTs pursuant to the
Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in paragraph 1
of this Agreement, exercise its authority under section 14301.4 of the Welfare and Institutions Code to
assess a 20 -percent assessment fee on the entire amount of the non-federal share IGTs to reimburse State
DHCS for the administrative costs of operating the IGT program pursuant to this section and for the
support of the Medi -Cal program.
2.2 The funds subject to the 20 -percent assessment fee shall be limited to non-federal
share IGTs made by the transferring entity, GOVERNMENTAL FUNDING ENTITY, pursuant to the
Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in paragraph 1
of this Agreement.
2.3 The 20 -percent fee will be assessed on the entire amount of the non-federal share
IGTs pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as
described in paragraph 1 of this Agreement, and will be made in addition to, and transferred separately
from, the transfer of funds pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of
Public Funds.
2.4 The 20 -percent assessment fee pursuant to this Agreement is non-refundable and
shall be wired to State DHCS separately from, and simultaneous to, the non-federal share IGTs pursuant
to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in
paragraph 1 of this Agreement. However, if any portion of the non-federal share IGTs is not expended for
the specified rate increases stated in paragraph 2.2 of the Intergovernmental Agreement(s) Regarding the
Transfer of Public Funds, DHCS shall return a proportionate amount of the 20 -percent assessment fee to
the GOVERNMENTAL FUNDING ENTITY.
2
CONTRACT 4 16-93710
Other Provisions
3.1 This Agreement contains the entire Agreement between the parties with respect to
the 20 -percent assessment fee on non-federal share IGTs pursuant to the Intergovernmental Agreement(s)
Regarding the Transfer of Public Funds, and as described in paragraph 1, and supersedes any previous or
contemporaneous oral or written proposals, statements, discussions, negotiations or other agreements
between the GOVERNMENTAL FUNDING ENTITY and State DHCS. This Agreement is not,
however, intended to be the sole agreement between the parties on matters relating to the funding and
administration of the Medi -Cal program. One or more other agreements may exist between the parties
regarding such other matters, and other agreements may be entered into in the future. This Agreement
shall not modify the terms of any other agreement between the parties.
3.2 Time is of the essence in this Agreement.
3.3 Each party hereby represents that the person(s) executing this Agreement on its
behalf is duly authorized to do so.
4. State Authority. Except as expressly provided herein, nothing in this Agreement shall be
construed to limit, restrict, or modify State DHCS' powers, authorities, and duties under federal and state
law and regulations.
5. Approval. This Agreement is of no force and effect until signed by the parties.
CONTRACT 4 16-93710
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of the last
signature below.
THE CITY OF SAN RAFAEL
By: Date: S--16 I
Jim chutz, City Manager, City of San Rafael
1400 Fifth Avenue
San Rafael, CA 94901
A(pJproved As To Form:
0 S&jW�-,-4,1ZFC
City Attorney, City f Sanafael
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date:
Jennifer Lopez, Acting Division Chief, Capitated Rates Development Division
4
CONTRACT # 16-93679
INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF HEALTH CARE
SERVICES ("DHCS") and the City of San Rafael (GOVERNMENTAL FUNDING ENTITY) with
respect to the matters set forth below.
RECITALS
A. This Agreement is made pursuant to the authority of Welfare & Institutions Code, sections
14164 and 14301.4.
B. The Partnership HealthPlan of California (HEALTH PLAN) is a County Organized Ilealth
System formed pursuant to Welfare and Institutions Code section 14087.54 and County Code Chapter
7.58, County Code Chapter 2.45, County Code Chapter 2, Title 2, and County Code Chapter 34.
HEALTH PLAN is a party to a Medi -Cal managed care contract with DHCS, entered into pursuant to
Welfare and Institutions Code section 14087.3, under which HEALTH PLAN arranges and pays for the
provision of covered Medi -Cal health care services to eligible Medi -Cal members residing in the County.
THEREFORE, the parties agree as follows:
AGREEMENT
1. Transfer of Public Funds
1.1 The GOVERNMENT FUNDING ENTITY shall transfer funds to DHCS pursuant
to sections 14164 and 14301.4 of the Welfare and Institutions Code, up to a maximum total amount of
Two Hundred Thirty Six Thousand, Nine Hundred Seventy Five Dollars ($236,975) for the period of
July 1, 2015 through June 30, 2016, and a maximum total amount of Two Hundred Fifty One Thousand,
Nine Hundred Seventy Two Dollars ($251,972) for the period of July 1, 2016 through June 30, 2017, to
be used solely as a portion of the nonfederal share of actuarially sound Medi -Cal managed care capitation
rate increases for HEALTH PLAN for the periods of July 1, 2015 through June 30, 2016, and July 1, 2016
CONTRACT # 16-93679
through June 30, 2017 as described in section 2.2 below. The funds shall be transferred in accordance
with a mutually agreed upon schedule between the GOVERNMENTAL FUNDING ENTITY and DHCS,
in the amounts specified therein.
1.2 The GOVERNMENTAL FUNDING ENTITY shall certify that the funds
transferred qualify for federal financial participation pursuant to 42 C.F.R. part 433 subpart B, and are not
derived from impermissible sources such as recycled Medicaid payments, federal money excluded from
use as State match, impermissible taxes, and non -bona fide provider -related donations. For transferring
units of government that are also direct service providers, impermissible sources do not include patient
care or other revenue received from programs such as Medicare or Medicaid to the extent that the
program revenue is not obligated to the State as the source of funding.
2. Acceptance and Use of Transferred Funds by DHCS
2.1 DHCS shall exercise its authority under section 14164 of the Welfare and
Institutions Code to accept funds transferred by the GOVERNMENTAL FUNDING ENTITY pursuant to
this Agreement as intergovernmental transfers ("IGTs"), to use for the purpose set forth in section 2.2
below.
2.2 The funds transferred by the GOVERNMENTAL FUNDING ENTITY pursuant to
this Agreement shall be used to fund a portion of the nonfederal share of increases in Medi -Cal managed
care actuarially sound capitation rates described in paragraph (4) of subdivision (b) of section 14301.4 of
the Welfare and Institutions Code and shall be paid, together with the related federal financial
participation, by DHCS to HEALTH PLAN as part of HEALTH PLAN'S capitation rates for the periods
of July 1, 2015 through June 30, 2016 and July 1, 2016 through June 30, 2017. The rate increases paid
under section 2.2 shall be used for payments related to Medi -Cal services rendered to Medi -Cal
2
CONTRACT # 16-93679
beneficiaries. The rate increases paid under this section 2.2 shall be in addition to, and shall not replace or
supplant, all other amounts paid or payable by DHCS or other State agencies to HEALTH PLAN.
2.3 DHCS shall seek federal financial participation for the rate increases specified in
section 2.2 to the full extent permitted by federal law.
2.4 The parties acknowledge the State DHCS will obtain any necessary approvals
from the Centers for Medicare and Medicaid Services prior to the payment of any rate increase pursuant
to section 2.2.
2.5 The parties agree that none of these funds, either GOVERNMENTAL FUNDING
ENTITY or federal matching funds will be recycled back to the GOVERMENTAL FUNDING
ENTITY'S general fund, the State, or any other intermediary organization. Payments made by the
HEALTH PLAN to providers under the terms of this Agreement and their provider agreement constitute
patient care revenues.
2.6 Within One Hundred Twenty (120) calendar days of the execution of this
Agreement, DHCS shall advise the GOVERNMENTAL FUNDING ENTITY and HEALTH PLAN of the
amount of the Medi -Cal managed care capitation rate increases that DHCS paid to HEALTH PLAN
during the applicable rate year involving any funding under the terms of this Agreement.
2.7 If any portion of the funds transferred by the GOVERNMENTAL FUNDING
ENTITY pursuant to this Agreement is not expended for the specified rate increases under Section 2.2,
DHCS shall return the unexpended funds to the GOVERNMENTAL FUNDING ENTITY.
Amendments
3.1 No amendment or modification to this Agreement shall be binding on either party
unless made in writing and executed by both parties.
3
CONTRACT # 16-93679
3.2 The parties shall negotiate in good faith to amend this Agreement as necessary and
appropriate to implement the requirements set forth in section 2 of this Agreement.
4. Notices. Any and all notices required, permitted or desired to be given hereunder by one
party to the other shall be in writing and shall be delivered to the other party personally or by United
States first class, certified or registered mail with postage prepaid, addressed to the other party at the
address set forth below:
To the GOVERNMENTAL FUNDING ENTITY:
Chris Gray
Fire Chief
The City of San Rafael Fire Department
1600 Los Gamos Drive Suite #345
San Rafael, Ca 94903
chris.arav a,citvofsanrafael.org
With copies to:
To DHCS:
Jim Schutz
City Manager
City of San Rafael
14005 th Ave
San Rafael, Ca 94901
iim.schutz a,citvofsanrafael.org
Carolyn Stewart
Senior Director of Financial Analysis
Partnership HealthPlan of California
4665 Business Center Drive
Fairfield, CA 94534
cstewart@partnership.org
Sandra Dixon
California Department of Health Care Services
4
CONTRACT # 16-93679
Capitated Rates Development Division
1501 Capitol Ave., Suite 71-4002
MS 4413
Sacramento, CA 95814
Sandra.Dixon@dhcs.ca.gov
5. Other Provisions
5.1 This Agreement contains the entire Agreement between the parties with respect to
the Medi -Cal rate increases for HEALTH PLAN described in section 2.2 that are funded by the
GOVERNMENTAL FUNDING ENTITY and supersedes any previous or contemporaneous oral or
written proposals, statements, discussions, negotiations or other agreements between the
GOVERNMENTAL FUNDING ENTITY and DHCS. This Agreement is not, however, intended to be
the sole agreement between the parties on matters relating to the funding and administration of the Medi -
Cal program. One or more other agreements already exist between the parties regarding such other
matters, and other agreements may be entered into in the future. This Agreement shall not modify the
terms of any other agreement between the parties.
5.2 The nonenforcement or other waiver of any provision of this Agreement shall not
be construed as a continuing waiver or as a waiver of any other provision of this Agreement.
Agreement.
5.3 Section 2 of this Agreement shall survive the expiration or termination of this
5.4 Nothing in this Agreement is intended to confer any rights or remedies on any third
party, including, without limitation, any provider(s) or groups of providers, or any right to medical
services for any individual(s) or groups of individuals; accordingly, there shall be no third party
beneficiary of this Agreement.
5.5 Time is of the essence in this Agreement.
5
CONTRACT # 16-93679
5.6 Each party hereby represents that the person(s) executing this Agreement on its
behalf is duly authorized to do so.
6. State Authoritv. Except as expressly provided herein, nothing in this Agreement shall be
construed to limit, restrict, or modify the DHCS' powers, authorities, and duties under federal and state
law and regulations.
7. Approval. This Agreement is of no force and effect until signed by the parties.
8. Term. This Agreement shall be effective as of July 1, 2015 and shall expire as of
June 30, 2019 unless terminated earlier by mutual agreement of the parties.
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of
the last signature below.
THE CITY OF SAN RAFAEL
By:
INS. Date: 46 ( 7
im S hutz, City rager,ty of San Rafael
Approved As To Form:
City Attorney, City of an Ra el
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
IM
Jennifer Lopez, Acting Division Chief,
Capitated Rates Development Division
Date:
6
HEAL TH PLAN-PROVIDER AGREEMENT
PARTNERSHIP HEALTHPLAN OF CALIFORNIA & CITY OF SAN RAFAEL
AMENDMENT 3
This Amendment is made this i/AJ+;fay of A-pn -/(month/year) by and between
PARTNERSHIP HEAL THPLAN OF CALIFORNIA, a County Organized Health System
hereinafter referred to as "PLAN", and CITY OF SAN RAFAEL FIRE DEPARTMENT
hereinafter referred to as "PROVIDER".
RECITALS:
WHEREAS, PLAN and PROVIDER have previously entered into an Agreement
effective June 6, 2014;
WHEREAS , Section 9.2 of such Agreement provides for amending such
Agreement;
WHEREAS, PLAN has been created by its Boards of Supervisors to negotiate
exclusive contracts with the California Department of Health Care Services and to arrange for
the provision of health care services to qualifying individuals in Marin County and PLAN is a
public entity, created pursuant to Welfare and Institutions Code 14087.54 and County Code
Chapters 7.2, County Code Chapters 34, County Code Chapters 2.40, County Code Chapters 2.0,
8.69, and County Code Chapters 2.0.
WHEREAS , The City of San Rafael Fire Department provides emergency
medical services and contract with the PLAN to provide these services to Medi-Cal
beneficiaries;
WHEREAS, PLAN and PROVIDER desire to amend the Agreement to provide
for Medi-Cal managed care capitation rate increases to PLAN as a result of intergovernmental
transfers ("IGTs") from City of San Rafael (GOVERNMENTAL FUNDING ENTITY) to the
California Department of Health Care Services ("State DHCS") to maintain the availability of
Medi-Cal health care services to Medi-Cal beneficiaries.
NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows:
Attachment D of the Agreement is added to amend the agreement as follows:
IGT MEDI-CAL MANAGED CARE CAPITATION RATE RANGE INCREASES
1. IGT Capitation Rate Range Increases to PLAN
A. Payment
q-3-3 \
Should PLAN receive any Medi-Cal managed care capitation rate increases from
State DHCS where the nonfederal share is funded by the GOVERNMENTAL FUNDING
ENTITY specifically pursuant to the provisions of the Intergovernmental Agreement Regarding
Transfer of Public Funds, #16-93679 ("Intergovernmental Agreement") effective for the periods
of July 1,2015 through June 30,2016 and July 1,2016 through June 30, 2017 for
Intergovernmental Transfer Medi-Cal Managed Care Rate Range Increases ("IGT MMCRRIs"),
PLAN shall pay to PROVIDER the amount of the IGT MMCRRIs received from State DHCS, in
accordance with paragraph I.E below regarding the form and timing of Local Medi-Cal
Managed Care Rate Range ("LMMCRR") IGT Payments. LMMCRR IGT Payments paid to
PROVIDER shall not replace or supplant any other amounts paid or payable to PROVIDER by
PLAN.
B. Health Plan Retention
(1) Medi-Cal Managed Care Seller's Tax
(a) The PLAN shall be responsible for any Medi-Cal Managed Care
Seller's ("MMCS") tax due pursuant to the Revenue and Taxation Code Section 6175 relating to
any IGT MMCRRIs through June 30, 2016. If the PLAN receives any capitation rate increases
for MMCS taxes based on the IGT MMCRRIs, PLAN may retain an amount equal to the amount
of such MMCS tax that PLAN is required to pay to the State Board of Equalization, and shall
pay, as part of the LMMCRR IGT Payments, the remaining amount of the capitation rate
increase to PROVIDER.
(b) This paragraph does not apply to any service months on or after
July 1,2016.
(2) The PLAN shall retain a three percent (3%) administrative fee based on
the total amount of the IGT MMCRRI received from DHCS for PLAN's cost to administer this
program. Each provider's share of the three percent (3%) fee shall be calculated based on the
provider's proportionate share of the LMMCRR IGT payment made by PLAN in the
PROVIDER'S County.
(3) PLAN will not retain any other portion of the IGT MMCRRIs received
from the State DHCS other than those mentioned above.
C. Conditions for Receiving Local Medi-Cal Managed Care Rate Range IGT
Payments
As a condition for receiving LMMCRR IGT Payments, PROVIDER shall, as of
the date the particular LMMCRR IGT Payment is due:
(1) remain a participating provider in the PLAN and not issue a notice of
(2) maintain its current emergency response services for PLAN Medi-Cal
beneficiaries.
2
D. Schedule and Notice or Transrer or Non-Federal Funds
PROVIDER shall provide PLAN with a copy of the schedule regarding the
transfer of funds to State DHCS, referred to in the Intergovernmental Agreement, within fifteen
(15) calendar days of the PROVIDER establishing such schedule with the State DHCS.
Additionally, PROVIDER shall notify PLAN, in writing, no less than seven (7) calendar days
prior to any changes to an existing schedule including, but not limited to, changes in the amounts
specified therein.
E. Form and Timing or Payments
PLAN agrees to pay LMMCRR lOT Payments to PROVIDER in the following
form and according to the following schedule:
(1) PLAN agrees to pay the LMMCRR lOT Payments to PROVIDER using
the same mechanism through which compensation and payments are normally paid to
PROVIDER (e.g ., electronic transfer).
(2) PLAN will pay the LMMCRR lOT Payments to PROVIDER no later than
thirty (30) calendar days after receipt of the lOT MMCRRIs from State DHCS.
F. Consideration
(1) As consideration for the LMMCRR lOT Payments, PROVIDER shall use
the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT
Payments in the following manner:
(a) The LMMCRR IGT Payments shall represent compensation for
Medi-Cal services rendered to Medi-Cal PLAN members by PROVIDER during the State fiscal
year to which the LMMCRR lOT Payments apply.
(b) To the extent that total payments received by PROVIDER for any
State fiscal year under this Amendment exceed the cost of Medi-Cal services provided to Medi-
Cal beneficiaries by PROVIDER during that fiscal year, any remaining LMMCRR lOT Payment
amounts shall be retained by PROVIDER to be expended for health care services. Retained
LMMCRR IGT Payment amounts may be used by the PROVIDER in either the State fiscal year
for which the payments are received or subsequent State fiscal years.
(2) For purposes of subsection (1) (b) above, if the retained LMMCRR lOT
Payments, ifany, are not used by PROVIDER in the State fiscal year received, retention of funds
by PROVIDER will be established by demonstrating that the retained earnings account of
PROVIDER at the end of any State fiscal year in which it received payments based on
LMMCRR IGT Payments funded pursuant to the Intergovernmental Agreement, has increased
over the unspent portion of the prior State fiscal year's balance by the amount ofLMMCRR IGT
Payments received, but not used. These retained PROVIDER funds may be commingled with
other GOVERNMENTAL FUNDING ENTITY funds for cash management purposes provided
3
that such funds are appropriately tracked and only the depositing facility is authorized to expend
them.
(3) Both parties agree that none of these funds, either from the
GOVERNMENTAL FUNDING ENTITY or federal matching funds will be recycled back to the
GOVERNMENTAL FUNDING ENTITY'S general fund, the State, or any other intermediary
organization. Payments made by the health plan to providers under the terms of this Amendment
constitute patient care revenues.
G. PLAN's Oversight Responsibilities
PLAN's oversight responsibilities regarding PROVIDER's use of the LMMCRR
IGT Payments shall be limited as described in this paragraph. PLAN shall request, within thirty
(30) calendar days after the end of each State fiscal year in which LMMCRR IGT Payments
were transferred to PROVIDER, a written confirmation that states whether and how PROVIDER
complied with the provisions set forth in Paragraph I.F above. In each instance, PROVIDER
shall provide PLAN with written confirmation of compliance within thirty (30) calendar days of
PLAN's request.
H. Cooperation Among Parties
Should disputes or disagreements arise regarding the ultimate computation or
appropriateness of any aspect of the LMMCRR IGT Payments, PROVIDER and PLAN agree to
work together in all respects to support and preserve the LMMCRR IGT Payments to the full
extent possible on behalf of the safety net in Marin County.
I. Reconciliation
Within one hundred twenty (120) calendar days after the end of each of PLAN's
fiscal years in which LMMCRR IGT Payments were made to PROVIDER, PLAN shall perform
a reconciliation of the LMMCRR IGT Payments transmitted to the PROVIDER during the
preceding fiscal year to ensure that the supporting amount oflGT MMCRRIs were received by
PLAN from State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCRR
IGT Payments made in error to PROVIDER within thirty (30) calendar days after receipt from
PLAN ofa written notice of the overpayment error, unless PROVIDER submits a written
objection to PLAN. Any such objection shall be resolved in accordance with the dispute
resolution processes set forth in Section 10.3 of the Agreement. The reconciliation processes
established under this paragraph are distinct from the indemnification provisions set forth in
Section J below. PLAN agrees to transmit to the PROVIDER any underpayment of LMMCRR
IGT Payments within thirty (30) calendar days of PLAN's identification of such underpayment.
J. Indemnification
PROVIDER shall indemnify PLAN in the event DHCS or any other federal or
state agency recoups, offsets, or otherwise withholds any monies from or fails to provide any
monies to PLAN, or PLAN is denied any monies to which it otherwise would have been entitled,
as a direct result of the LMMCRR IGT arising from the Intergovernmental Agreement.
Recovery by PLAN pursuant to this section shall include, but not be limited to, reduction in
4
future LMMCRR IGTs paid to PROVIDER in an amount equal to the amount ofMMCRRI
payments withheld or recovered from PLAN, or by reduction of any other amounts owed by
PLAN to PROVIDER.
2. Term
The term of this Amendment shall commence on July 1,2015 and shall terminate
on September 30,2019.
3.
All other terms and provisions of said Agreement shall remain in full force and
effect so that all rights, duties and obligations, and liabilities of the parties hereto otherwise
remain unchanged; provided, however, ifthere is any conflict between the terms of this
Amendment and the Agreement, then the terms of this Amendment shall govern.
SIGNATURES
Date: rrQ~a~I8011
By: Elizabeth Gibboney, CEO , Partnership HealthPlan of California
PROVIDER: __ -F~~~+==-~-+ ________ __ Date: 5--16 -! 7
By: Jim Schutz, . Manager, City 0
1400 Fifth Avenue
San Rafael, CA 94901
Approved As To Form:
~/~(1~~~e
City Attorney, cTt)fOfSIlRara I
5
CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Fire
Project Manager: Danielle Ferrigno
Extension: 3138
Project: Intergovernmental Transfer Agreements
Contractor Name: State of California DHCS
Contractor's Contact: Sandra Dixon
Contact's Email: mailto❑ FPPC: Check if Contractor/Consultant must file Form 700
StepRESPONSIBLE
I
DEPARTMENT
1 1 Project Manager
2 City Attorney
3 1 Project Manager
4
i
i
E
DESCRIPTION
a. Email PINS Introductory Notice to Contractor
b. Email contract (in Word) & attachments to City
Atty c/o Laraine.Gittens@cityofsanrafael.org
a. Review, revise, and comment on draft agreement
and return to Project Manager
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
Forward three (3) originals of final agreement to
contractor for their signature
Project Manager When necessary, * contractor -signed agreement
agendized for Council approval
*PSA > $20,000; or Purchase > $35,000; or
Public Works Contract > $125,000
Date of Council approval
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
Project Manager
Forward signed original agreements to City
Attorney with printed copy of this routing form
City Attorney
Review and approve hard copy of signed
agreement
City Attorney
Review and approve insurance in PINS, and bonds
(for Public Works Contracts)
City Manager/ Mayor
Agreement executed by Council authorized official
City Clerk
Attest signatures, retains original agreement and
forwards copies to Project Manager
COMPLETED
DATE
Not Needed
5/1/2017
5/8/2017
5/8/2017
We need to
sign first and
we need five
signed originals
❑ N/A
Or
5/15/2017
5/8/2017
REVIEWER
Check/Initial
Z LAG
Z LAG
N/A
DF