HomeMy WebLinkAboutFD Ambulance Service Cost Recovery____________________________________________________________________________________
FOR CITY CLERK ONLY
File No.: DHCS File 4-3-713 x PHC File 4-3-714
Council Meeting: 6/18/2018
Disposition: Resolution 14520
Agenda Item No: 4.g
Meeting Date: June 18, 2018
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Christopher Gray
Fire Chief
City Manager Approval: ______________
TOPIC: Ambulance Service Cost Recovery
SUBJECT: 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
2017-2018.
RECOMMENDATION:
Adopt a resolution authorizing the City Manager to execute agreements to allow the City of San Rafael Fire
Department to participate in Intergovernmental Transfers with the California Department of Health Care Services
for FY 2017-2018.
EXECUTIVE SUMMARY:
This request for the City Manager to execute agreements on behalf of the City for participation in a Medi-Cal rate
range Intergovernmental Transfer (IGT) for rate year FY 2017-2018 represents the fifth year of the City’s
participation in the Intergovernmental Transfer Program that assists the City in recovering costs association with
provision of Emergency Medical Services to the Managed Medi-Cal population.
BACKGROUND:
Since 2006, the Department of Health Care Services (DHCS) has offered public healthcare providers the
opportunity to participate in a program that increases reimbursement for services provided to Medi -Cal managed
care plan members. The DHCS program, called a voluntary rate range Intergovernmental Transfer (IGT) program
(Welfare and Institutions Code §§14164, 14301.4) provides a way for “Medi-Cal Managed Care Health Plan
Providers” to gain access to federal matching funds for Medi-Cal reimbursements. In 2015, this program was
expanded to include public Emergency Medical Services (“EMS”) providers, like the San Rafael Fire Department,
who provides health care services to Medi-Cal managed care enrollees making them eligible to receive increased
reimbursements from Med-Cal Managed Care Health Plan Providers.
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
Under the IGT program, counties and other political subdivisions or governmental entities in the State may elect
to transfer funds to the State in support of the Medi-Cal program. These funds are used as a match for federal
funds, which are eventually returned to the EM S providers through their respective Medi-Cal Managed Care
Health Plan Providers. In Marin County, the Medi-Cal Managed Care Health Plan Provider is called Partnership
Health Plan of California (PHC). PHC has agreed to participate in the IGT program along with its regional
partners, San Rafael Fire Department, Marin County Health and Human Services, Marin General Hospital,
Novato Fire District and Southern Marin Fire District.
ANALYSIS:
Overview of IGT Process: The IGT program requires the transfer of eligible local dollars from the City to the
DHCS. DHCS in turn uses transferred funds from local governments to increase monthly capitation rates it paid
Medi-Cal Managed Care Health Plan Providers in the prior f iscal year, thus allowing DHCS to receive additional
federal funding from the Centers for Medicare and Medicaid Services (CMS) for payment to the Medi -Cal
Managed Care Health Plan Providers. The Medi-Cal Managed Care Health Plan Providers then pay most of their
IGT funded rate increases to the local governments that transferred the funds. Ultimately, each local government
participant receives back the funding it provided, plus the federal match in return.
PHC began discussions with DHCS in November of 2017 in order to notify the State of the County’s interest in
participating in the IGT program. PHC then notified the San Rafael Fire Department that a non -binding letter of
interest must be submitted. The Department submitted the non-binding letter of interest and has been working
with both DHCS and PHC in developing the necessary agreements for participation. In April 2018, DHCS
provided the Department with an estimated transfer amount and timeline for the FY 2017-2018 rate range
program.
Participation in the IGT program provides an important opportunity for the City to collect ambulance transport fees
that would not otherwise be available. Currently, the Medi-Cal program reimburses approximately $125 per
emergency ambulance transport, which is less than 10% of the actual cost to provide the service.
State DHCS Rate Increase Contract: Based on the participating agencies’ signed contracts to transfer funds to
DHCS, the state will contact PHC to increase its per-member, per-month capitation rates. The Plan’s rate will be
increased to the highest actuarially sound rate.
Transfer from the Department to the State: Once the CMS has approved the entire IGT transaction, and the
Plan rate contracts have been signed by DHCS and the Medi-Cal Managed Care Health Plans throughout the
State, DHCS will submit a request to participating agencies to transfer funds to the State. With the Council’s
approval, the Fire Department will transfer $213,243 to DHCS for FY 17-18. Additionally, the Department will
make a separate payment of approximately $42,649 (20%) to DHCS as authorized in Welfare and Institutions
Code Section 14301.4, to cover the administrative costs (assessment fee) of operating the IGT program for FY
17-18. If the State is unable to use all of the transferred funds to increase Plan rates, it will return any used funds
and the associated 20% administrative fee.
Payment to the Fire Department: The San Rafael Fire Department expects to receive approximately $443,867
for FY 17-18, an amount that is comprised of the original contributions and the federal matched funds. This
estimated amount is based on the ratio of IGT revenue relative to transfers from the Department to the state from
prior years. When the 20% pre-paid administrative fee is considered, the resulting net revenue received by the
Fire Department is expected to be approximately $187,975 for FY 17-18.
New Federal matching funds received by the Fire Department will be used to promote the well-being of PHC
beneficiaries by maintaining or improving the current service levels of the paramedic program.
The rate range IGT will be implemented through execution of separate contracts with the DHCS and with PHC.
These documents spell out the obligations of each entity in regard to the transfer of local government funds, the
use of funds by DHCS, the payment of funds to PHC, and the treatment of payments by PHC . Before any funds
are transferred, all the contracts must be signed by the participating agencies and the Plan rate increases must
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3
be approved by the federal government. The specific contract documents for Rate Year 2017-2018 need to be
returned to DHCS by July 31, 2018. On May 17, 2018, the Department received an agreement from DHCS for
the City Manager’s signature; this is attached as Exhibit I to the proposed Resolution (Attachment 2). On June
11, 2018, the City received a proposed agreement from PHC; this is attached as Exhibit II to the proposed
Resolution (Attachment 3).
FISCAL IMPACT:
The IGT will support the Emergency Medical Services Fund in recovering a greater portion of its transport costs.
The Department requests City Council approval to pursue participation in an IGT to secure additional federal
matching funds to support health care services to the Medi-Cal eligible population.
Attachment 4 provides approximate transfer amounts based on information provided to the department by PHC,
the County’s Medi-Cal Managed Health Care Plan Provider. A summary of the amount the City expects to transfer
to DHCS and receive back through participation in this program is outlined below.
Fiscal Year Transfer
Amount Admin Fee Funds Returned by
PHC
Net New
Funds
FY 17-18 $213,243 $42,649 $443,867 $187,975
The proposed funds to be transferred to the State will be allocated from the Department’s Emergency Medical
Services Fund and are expected to be transferred in November 2018. The funds will return to the Department as
enhanced Medi-Cal payments approximately six to eight weeks later.
OPTIONS:
1. Adopt resolution authorizing the City Manager to execute agreements to allow the City of San Rafael Fire
Department to participate in Intergovernmental Transfers with the California Department of Health Care
Services for FY 2017-2018.
2. Adopt resolution with modifications authorizing the City Manager to execute agreements to allow the City
of San Rafael Fire Department to participate in Intergovernmental Transfers with the California
Department of Health Care Services for FY 2017-2018.
3. Direct staff to return with more information.
4. Take no action.
RECOMMENDED ACTION:
Adopt Resolution Authorizing the City Manager to execute agreements to allow the City of San Rafael Fire
Department to participate in an Intergovernmental Transfer with the California Department of Health Care
Services, in a form to be approved by the City Attorney.
ATTACHMENTS:
1. Resolution
2. Exhibit I to Resolution: IGT Agreement for FY 2017-2018
3. Exhibit II to Resolution: Health Plan-Provider Agreement for FY 2017-2018
4. San Rafael Fire Department Allocation Estimates FY 2017-2018
RESOLUTION NO. 14520
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 2017-2018.
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 (PHC) members for FY 2017-2018, and authorizes the City Manager to execute the
Intergovernmental Agreement Regarding Transfer of Public Funds attached hereto as Exhibit I
and incorporated herein by reference, subject to final approval as to form by the City Attorney.
BE IT FURTHER RESOLVED, that the City Council hereby authorizes the City Manager to
execute the Health Plan-Provider Agreement with PHC attached hereto as Exhibit II and
incorporated herein by reference, for the San Rafael Fire Department’s participation in an
Intergovernmental Transfer, 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 July 1, 2017 through June 30, 2018.
I, LINDSAY LARA, 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 18th day of June, 2018, by the following vote, to wit:
AYES: COUNCILMEMBERS: Bushey, McCullough & Vice-Mayor Gamblin
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: Colin & Mayor Phillips
______________________________
LINDSAY LARA, City Clerk
CONTRACT #17-94812
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,FIRE
DEP ARTMENT (GOVERNMENTAL FUNDING ENTITY) with respect to the matters set forth
below.
The parties agree as follows:
AGREEMENT
1. Transfer of Public Funds
1.1 The GOVERNMENTAL FUNDING ENTITY agrees to make a transfer
of funds to DHCS pursuant to sections 14164 and 14301.4 of the Welfare and Institutions Code.
The amount transferred shall be based on the sum of the following rate category per member per
month (PMPM) contribution· increments multiplied by member months:
Funding Entity: . ~ity of San Rafael Fire Department
Health Plan: ~artnership
Rating Region: Marin
Estimated
Contribution Estimated Contribution (Non-
Rate Category PMPM Member Months Federal Share)
Child -non MCHIP $ 0.30 120,452 $ 36,136
Child -MCHIP $ 0.07 62,220 $ 4,355
Adult -non MCHIP $ 0.72 51,994 $ 37,436
Adult -MCHIP $ 0.17 3,040 $ 517
SPD $ 2.41 26,471 $ 63,795
SPD Full Dual $ 0.36 51,105 $ 18,398
BCCTP $ 5.05 688 $ 3,472
LTC $ 12.78 117 $ 1,495
LTC Full Duals $ 7.49 4,302 $ 32,218
Optional Expansion
7/2017 -1212017 $ 0.09 77,180 $ 6,946
Optional Expansion
1/2018 -6/2018 $ 0.11 77,044 $ 8,475
Estimated Total 474,611 213,243
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The GOVERNMENTAL FUNDING ENTITY agrees to initially transfer amounts that are
calculated using the Estimated Member Months in the chart above, which will be reconciled to
actual enrollment for the service period of July 1,2017 through June 30,2018 in accordance with
Sub-Section 1.3 of this Agreement. The funds transferred shall be used as described in Sub-
Section 2.2 of this Agreement. The funds shall be transferred in accordance with the terms and
conditions, including schedule and amount, established by DHCS.
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. 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.
1.3 DHCS shall reconcile the "Estimated Member Months," in Sub-Section
1.1 of this Agreement, to actual enrollment in HEALTH PLAN(S) for the service period of
July 1,2017 through June 30, 2018 using actual enrollment figures taken from DHCS records.
Enrollment reconciliation will occur on an ongoing basis as updated enrollment figures become
available . Actual enrollment figures will be considered fmal two years after June 30,2018. If
this reconciliation results in an increase to the total amount necessary to fund the nonfederal
share of the payments described in Sub-Section 2 .2, the GOVERNMENTAL FUNDING
ENTITY agrees to transfer any additional funds necessary to cover the difference. If this
reconciliation results in a decrease to the total amount necessary to fund the nonfederal share of
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CONTRACT #17-94812
the payments described in Sub-Section 2.2, DHCS agrees to return the unexpended funds to the
GOVERNMENTAL FUNDING ENTITY. IfDHCS and the GOVERNMENTAL FUNDING
ENTITY mutually agree, amounts due to or owed by the GOVERNMENTAL FUNDING
ENTITY may be offset against future transfers.
2. Acceptance and Use of Transferred Funds
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 IGTs, to use for the purpose set forth in Sub-Section 2.2.
2.2 The funds transferred by the GOVERNMENTAL FUNDING ENTITY
pursuant to Section 1 of this Agreement shall be used to fund the non-federal share ofMedi-Cal
Managed Care actuarially sound capitation rates described in section 14301.4(b)(4) of the
Welfare and Institutions Code as reflected in the contribution PMPM and rate categories
reflected in the chart set forth in Sub-Section 1.1. The funds transferred shall be paid, together
with the related Federal Financial Participation, by DHCS to HEALTH PLAN(S) as part of
HEALTH PLAN(S)' capitation rates for the service period of July 1,2017 through June 30,
2018, in accordance with section 14301.4 of the Welfare and Institutions Code .
2.3 DHCS shall seek Federal Financial Participation for the capitation rates
specified in Sub-Section 2.2 to the full extent permitted by federal law.
2.4 The parties acknowledge that DHCS will obtain any necessary approvals
from the Centers for Medicare and Medicaid Services.
2.5 DHCS shall not direct HEALTH PLAN(S)' expenditure of the payments
received pursuant to Sub-Section 2.2.
3. Assessment Fee
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CONTRACT #17-94812
3.1 DHCS shall exercise its authority under section 14301.4 of the Welfare
and Institutions Code to assess a 20 percent fee related to the amounts transferred pursuant to
Section 1 of this Agreement, except as provided in Sub-Section 3.2. GOVERNMENTAL
FUNDING ENTITY agrees to pay the full amount of that assessment in addition to the funds
transferred pursuant to Section 1 of this Agreement.
3.2 The 20-percent assessment fee shall not be applied to any portion of funds
transferred pursuant to Section 1 that are exempt in accordance with sections 1430 1.4( d) or
14301.5(b)(4) of the Welfare and Institutions Code. DHCS shall have sole discretion to
determine the amount of the funds transferred pursuant to Section 1 that will not be subject to a
20 percent fee. DHCS has determined that $0.00 of the transfer amounts, will not be assessed a
20 percent fee, subject to Sub-Section 3.3.
3.3 The 20-percent assessment fee pursuant to this Agreement is non-
refundable and shall be wired to DHCS separately from, and simultaneous to, the transfer
amounts made under Section 1 of this Agreement. If, at the time of the reconciliation performed
pursuant to Sub-Section 1.3 of this Agreement, there is a change in the amount transferred that is
subject to the 20-percent assessment in accordance with Sub-Section 3.1, then a proportional
adjustment to the assessment fee will be made.
4. Amendments
4.1 No amendment or modification to this Agreement shall be binding on
either party unless made in writing and executed by both parties.
4.2 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.
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CONTRACT #17-94812
5. 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:
Jim Schutz, City Manager
City of San Rafael
1400 Fifth Avenue
San Rafael, CA 94901
Jim. Schutz@cityofsanrafael.org
With copies to:
ToDHCS:
Chris Gray, Fire Chief
San Rafael Fire Department
1600 Los Gamos Drive, Suite 345
San Rafael, CA 94903
Chris.Gray@cityofsanrafael.org
And
Carolyn Stewart
Senior Director of Financial Analysis
Partnership HealthPlan of California
4665 Business Center Drive
Fairfield, CA, 94534
CStewart@partnershiphp.org
Sandra Dixon
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., Suite 71-4002
MS 4413
Sacramento, CA 95814
Sandra.Dixon@dhcs.ca.gov
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CONTRACT #17-94812
6. Other Provisions
6.1 This Agreement contains the entire Agreement between the parties with
respect to the Medi-Cal payments described in Sub-Section 2.2 of this Agreement 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 relating to the
subject matter of this Agreement. 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. This Agreement shall not modify the terms of any other agreement, existing or
entered into in the future, between the parties.
6.2 The non-enforcement 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.
6.3 Sections 2 and 3 of this Agreement shall survive the expiration or
termination of this Agreement.
6.4 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.
6.5 Time is of the essence in this Agreement.
6.6 Each party hereby represents that the person(s) executing this Agreement
on its behalf is duly authorized to do so.
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CONTRACT #17-94812
7. State Authority. 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.
8. Approval. This Agreement is of no force and effect until signed by the parties.
9. Term. This Agreement shall be effective as ofJuly 1,2017 and shall expire as of
December 31,2020 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 RAF AEL,FIRE DEPARTMENT
By: Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date:
Jennifer Lopez, Acting Division Chief, Capitated Rates Development Division
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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: Christopher Gray
Extension: x3084
Contractor Name: California Department of Health Care Services (DHCS)
Contractor's Contact: Sandra Dixon
Contact's Email: Sandra.Dixon@dhcs.ca.gov
D FPPC: Check if Contractor/Consultant must file Form 700
Step
1
2
3
4
RESPONSIBLE
DEPARTMENT
Project Manager
City Attorney
Project Manager
Project Manager
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
When necessary, * contractor-signed agreement
agendized for Council approval
*P5A > $20,000; or Purchase> $35,000; or
Public Works Contract> $125,000
COMPLETED
DATE
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enter a date.
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D N/A
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Date of Council approval ( 6/18/2018 ,)
PRINT
5 Project Manager
6 City Attorney
7 City Attorney
CONTINUE ROUTING PROCESS WITH HARD COPY
Forward signed original agreements to City
Attorney with printed copy of this routing form
Review and approve hard copy of signed
agreement
Review and approve insurance in PIN,S I and bonds
(for Public Works Contracts) )J J A-
REVIEWER
Check/Initial
D
D
D
D
D
8 City Manager / Mayor Agreement executed by Council authorized official 6-U-//f tK
9 City Clerk Attest signatures, retains original agreement and
forwards copies to Project Manager
I
HEALTH PLAN -PROVIDER AGREEMENT
Partnership HealthPlan of California and City of San Rafael
AMENDMENT 4
This Amendment is made this 28 day of Juneby and between Partnership
HealthPlan of California, a County Organized Health System hereinafter referred to as "PLAN",
and City of San Rafael hereinafter referred to as "PROVIDER".
RECITALS:
WHEREAS, PLAN and PROVIDER have previously entered into an Agreement
effective June 1, 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 PLAN covered health care services to PLAN beneficiaries 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, 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 to the California Department of Health Care Services
("State DHCS") to maintain the availability of PLAN covered health care services to PLAN
beneficiaries.
NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows:
Attachment D of the Agreement is added to amend the agreement as follows:
San Rafael M/Partnership
IGT MEDI-CAL MANAGED CARE CAPITATION INCREASES
1. IGT Capitation Increases to PLAN
A. Payment
Should PLAN receive any Medi -Cal managed care capitation rate increases from
State DHCS where the nonfederal share is funded by the City of San Rafael effective July 1,
2017 for Intergovernmental Transfer Medi -Cal Managed Care Increases ("IGT MMCIs"), PLAN
shall pay to PROVIDER the amount of the IGT MMCIs received from State DHCS, in
accordance with paragraph LE below regarding the form and timing of Local Medi -Cal
Managed Care ("LMMC") IGT Payments. LMMC 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
The PLAN shall be responsible to pay the applicable State Agency
pursuant to the Revenue and Taxation Code Section 6175 relating to any IGT MMCIs.
(2) The PLAN shall retain a three percent (3%) administrative fee based on
the total amount of the IGT MMCIs received from DHCS for PLAN'S administrative costs.
Each provider's share of the 3% fee shall be calculated based on that provider's proportionate
share of the LMMCIGT payments made by Plan in the PROVIDER'S County.
C. Form and Timinia of Pavments
PLAN agrees to pay LMMCRR IGT Payments to PROVIDER in the following
form and according to the following schedule:
(1) PLAN agrees to pay the LMMC IGT 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 LMMCIGT Payments to PROVIDER no later than
thirty (30) calendar days after receipt of the IGT MMCIs from State DHCS.
D. Consideration
(1) As consideration for the LMMC IGT Payments, PROVIDER shall use the
LMMC IGT Payments for the following purposes and shall treat the LMMC IGT Payments in
the following manner:
(a) The LMMC IGT Payments shall represent compensation for Medi -
Cal PLAN services rendered to Medi -Cal PLAN members by PROVIDER during the State fiscal
year to which the LMMC IGT Payments apply.
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(2) If the retained LMMC IGT Payments, if any, 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 LMMC 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 of LMMC IGT Payments received, but not used.
(3) Both parties agree that none of these funds, either from the City of San
Rafal, or federal matching funds will be recycled back to the City of San Rafael 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.
E. Cooperation Among Parties
Should disputes or disagreements arise regarding the ultimate computation or
appropriateness of any aspect of the LMMC IGT Payments, PROVIDER and PLAN agree to
work together in all respects to support and preserve the LMMC IGT Payments to the full extent
possible on behalf of the safety net in Marin County.
F. Reconciliation
Within one hundred twenty (120) calendar days after the end of each of PLAN's
fiscal years in which LMMC IGT Payments were made to PROVIDER, PLAN shall perform a
reconciliation of the LMMC IGT Payments transmitted to the PROVIDER during the preceding
fiscal year to ensure that the supporting amount of IGT MMCIs were received by PLAN from
State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCIGT Payments
made in error to PROVIDER within thirty (30) calendar days after receipt from PLAN of a
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 LMMC IGT Payments within thirty
(30) calendar days of PLAN's identification of such underpayment.
G. 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 LMMC IGT arising from the Intergovernmental Agreement. Recovery
by PLAN pursuant to this section shall include, but not be limited to, reduction in future LMMC
IGTs paid to PROVIDER in an amount equal to the amount of MMCI payments withheld or
3
Template Version -1/20/12 San Rafael FD/Partnership
IGTs paid to PROVIDER in an amount equal to the amount of MMCI payments withheld or
recovered from PLAN, or by an offset of any other amounts owed by PLAN to PROVIDER,
including but not limited to payments for direct service rendered.
Remittance Information
The IGT -funded payments made by the PLAN pursuant to this Amendment only,
shall be mailed to the PROVIDER at the address set forth below:
Jim Schutz, City Manager
City of San Rafael
1400 Fifth Avenue
San Rafael, CA 94901
2. Term
The term of this Amendment shall commence on July 1, 2017 through June 30,
2020. PHC reserves the right to immediately terminate this IGT Amendment prior to June
30, 2020, if DHCS suspends or discontinues the IGT funding described in this
Amendment. PHC will promptly provide formal notice to the provider upon said
suspension or discontinuation.
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, if there is any conflict between the terms of this
Amendment and the Agreement, then the terms of this Amendment shall govern.
SIGNATURES
HEALTH PLAN: �- Date: xVtx Iq
, V
By: Elizabeth Gibboney, CEQ, Partnership HealthPlan u€ California
PROVIDER: 'NL U,
By: Jim Schutz,(City' anager, City oI San Rafael
Date:
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Template Version -1/20/12 San Rafael FD/Partnership
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: Christopher Gray
Extension: x3084
Contractor Name: Partnership HealthPlan of California (PHC)
Contractors Contact: Belinda Love
Contact's Email: blove@partnershiphp.org
D FPPC: Check if Contractor/Consultant must file Form 700
Step RESPONSIBLE DESCRIPTION
DEPARTMENT
1 Project Manager a. Email PINS Introductory Notice to Contractor
b. Email contract (in Word) & attachments to City
Atty c/o Laraine.Gittens@cityofsanrafael.org
2 City Attorney 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
3 Project Manager Forward three (3) originals of final agreement to
contractor for their signature
4 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
5 Project Manager Forward signed original agreements to City
Attorney with printed copy of this routing form
6 City Attorney Review and approve hard copy of signed
agreement
7 City Attorney Review and approve insurance in PIN)' and bonds
(for Public Works Contracts) k J k
8 City Manager / Mayor Agreement executed by Council authorized official
9 City Clerk Attest signatures, retains original agreement and
forwards copies to Project Manager
COMPLETED
DATE
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