Loading...
FD Intergovernmental Transfer 2018 PHP; Amendment 3HEAL TH PLAN-PROVIDER AGREEMENT PARTNERSHIP HEALTHPLAN OF CALIFORNIA & CITY OF SAN RAFAEL AMENDMENT 3 This Amendment is made this i!A#J-ay of IA;-IJn -/(monthlyear) by and between PARTNERSHIP HEAL THPLAN OF CALIFORNIA, a C~nty 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. lithe PLAN receives any capitation rate increases for MMCS taxes based on the IGT MMCRRls, 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 fonn 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 nonnally 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 rOT Payments, PROVIDER shall use the LMMCRR lOT Payments for the following purposes and shall treat the LMMCRR lOT 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 rOT 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, 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 LMMCRR lOT 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 lOT Payments received, but not used. These retained PROVIDER funds may be commingled with other OOVERNMENT AL 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 MMCRRls 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 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 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: ®~a:S)8011 By: Elizabeth Gibboney, CEO , Partnership HealthPlan of California PROVIDER: __ -r-T~~~~~-+ ________ __ Date: 5-..... 16 -! 7 By: Jim Schutz, . Manager, City 0 1400 Fifth Avenue San Rafael, CA 94901 Approved As To Form: £~(1~~r:e City Attorney, cTt)fOfSl1Rara 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: maiitoO FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor Not Needed 0 5/1/2017 b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael,org 1ZI 2 City Attorney a. Review, revise, and comment on draft agreement 5/8/2017 1ZI LAG and return to Project Manager 5/8/2017 1ZI LAG b. Confirm insurance requirements, create Job on N/A PINS, send PINS insurance notice to contractor 3 Project Manager Forward three (3) originals of final agreement to We need to 1ZI contractor for their signature sign first and we need five signed originals 4 Project Manager When necessary, * contractor-signed agreement 0 N/A agendized for Council approval 1ZI ·PSA > $20,000; or Purchase> $35 ,000 ; or Or Publ ic Works Contract> $125 ,000 Date of Council approval 5/15/2017 PRINT CONTINUE ROUTING PROCESS WITH HARD COpy 5 Project Manager Forward signed original agreements to City 5/8/2017 DF Attorney with printed copy of this routing form 6 City Attorney Review and approve hard copy of signed sj/~/J7 RS-agreement 7 City Attorney Review and approve insurance in PINS , and bonds sjJft,/r7 ;V~~ (for Public Works Contracts) 8 City Manager / Mayor Agreement executed by Council authorized official ,-lh -17 ~ 9 City Clerk Attest signatures, retains original agreement and -~. forwards copies to Project Manager tt;.)b ./7