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FD Intergovernmental Transfer 2020 DHCS (unsigned)CONTRACT #19-96398 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 DEPARTMENT (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 applicable rate category per member per month (PMPM) contribution increments multiplied by member months, as reflected in Exhibit 1. The GOVERNMENTAL FUNDING ENTITY agrees to initially transfer amounts that are calculated using the Estimated Member Months in Exhibit 1, which will be reconciled to actual enrollment for the service periods of July 1, 2019 through June 30, 2020, and July 1, 2020 through December 31, 2020, and reconciled to actual PMPMs for the service period of July 1, 2020 through December 31, 2020 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. Template Version - 12/2019 CONTRACT #19-96398 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 Exhibit 1, to actual enrollment in HEALTH PLAN(S) for the service periods of July 1, 2019 through June 30, 2020, and July 1, 2020 through December 31, 2020 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 final two years after June 30, 2020 and December 31, 2020, respectively. DHCS shall reconcile the "Projected Contribution PMPM," in Exhibit I (b), to actual PMPM for HEALTH PLAN(S) for the service period of July 1, 2020 through December 31, 2020 using actual PMPMs that result from the risk adjustment process as reflected in figures taken from DHCS records. PMPM reconciliation will occur on an ongoing basis as the risk adjustment process is finalized. Actual PMPM amounts will be considered final two years after December 31, 2020. If 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 reconciliation results in a decrease to the total amount necessary to fund the nonfederal share of the payments described in Sub -Section 2.2, DHCS agrees to return the unexpended funds to the GOVERNMENTAL FUNDING ENTITY. If 2 Template Version - 12/2019 CONTRACT #19-96398 DHCS 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 and Exhibit 1 of this Agreement shall be used to fund the non-federal share of Medi -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 Exhibit 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 periods of July 1, 2019 through June 30, 2020, and July 1, 2020 through December 31, 2020, 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 3 Template Version - 12/2019 CONTRACT #19-96398 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 fiinds transferred pursuant to Section 1 that are exempt in accordance with sections 14301.4(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 I 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. 4 Template Version - 12/2019 CONTRACT #19-96398 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.Schutzacityofsanrafael.org With copies to: To DHCS: Darin White, Fire Chief San Rafael Fire Department 1375 Fifth Avenue San Rafael, CA 94901 Darin. White acityofsanrafael.org Jeff Ingram, Director, FP&A Partnership Health Plan of California 4665 Business Center Drive Fairfield, CA 94534 iin rg am(a2partnershiphp.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 a,dhcs.ca.gov 5 Template Version - 12/2019 CONTRACT # 19-96398 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. 6 Template Version - 12/2019 CONTRACT #19-96398 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 of July 1, 2019 and shall expire as of June 30, 2023 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 FIRE DEPARTMENT: Date: Jim Schutz, City Manager, City of San Rafael THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES: Date: Rafael Davtian, Division Chief, Capitated Rates Development Division 7 Template Version - 1212019 CONTRACT #19-96398 Exhibit 1 Health Plan: Partnership Health Plan of California Rating Region: Southern Region Service Period 7/2019-12/2019 Rate Category Contribution PMPM Estimated Member Months* Estimated Contribution (Non - Federal Share) Child - non MCI HP $ 0.06 343,485 $ 20,609 Child - MCHIP $ 0.02 170,108 $ 3,402 Adult - non MCHIP $ 0.16 169,182 $ 27,069 Adult - MCHIP $ 0.06 5,902 $ 354 ACA Optional Expansion $ 0.02 362,721 $ 7,254 SPD $ 0.44 94,857 $ 41,737 SPD/Full-Dual $ 0.09 150,559 $ 13,550 BCCTP $ 0.79 616 $ 487 LTC $ 1.63 432 $ 704 LTC/Full Dual $ 0.97 7,619 $ 7,390 OBRA $ 0.17 844 $ 143 Whole Child Model $ 0.83 18,470 $ 15,330 Estimated Total 1,324,795 $ 138,029 Health Plan: Partnership Health Plan of California Rating Region: Southern Region Rating Region: 1/2020-6/2020 Rate Category Contribution PMPM Estimated Member Months* Estimated Contribution (Non - Federal Share) Child - non MCHIP $ 0.04 349,237 $ 13,969 Child - MCHIP $ 0.02 172,956 $ 3,459 Adult - non MCHIP $ 0.15 173,949 $ 26,092 Adult - MCHIP $ 0.06 6,068 $ 364 ACA Optional Expansion $ 0.03 370,973 $ 11,129 SPD $ 0.39 96,667 $ 37,700 SPD/Full-Dual $ 0.08 154,634 $ 12,371 BCCTP $ 0.76 617 $ 469 LTC $ 1.46 480 $ 701 LTC/Full Dual $ 0.87 7,769 $ 6,759 OBRA $ 0.15 914 $ 137 Whole Child Model $ 0.77 18,803 $ 14,478 Estimated Total 1,353,067 $ 127,628 Template Version - 12/2019 CONTRACT #19-96398 Exhibit 1(b) Health Plan: Patine rship Health Plan of California Rating Region: Southern Region Rating Region: 7/2020 -12/2020 Rate Category Projected Contribution PMPM** Estimated Member Months* Estimated Contnbution (Non - Federal Share) Child - non MCHIP $ 0.06 383,632 $ 23,018 Child - MCHIP $ 0.03 189,991 $ 5,700 Adult - non MCI IIP $ 0.15 193,036 $ 28,955 Adult - MCIIIP $ 0.09 6,734 $ 606 ACA Optional Expansion $ 0.03 418,517 $ 12,556 SPD $ 0.40 100,724 $ 40,290 SPD/Full-Dual $ 0.08 160,888 $ 12,871 BCCTP $ 0.77 685 $ 527 LTC $ 1.50 512 $ 768 LTC/Full Dual $ 0.89 8,396 $ 7,472 OBRA $ 0.15 1,179 $ 177 Whole Child Model $ 0.82 20,116 $ 16,495 Estimated Total 1,484,410 $ 149,435 * Note that Estimated Member Months are subject to variation, and the actual total Contribution (Non -Federal Share) may differ from the amount listed here. ** Note that Projected Contribution PMPMs are subject to change based on the risk adjustment process of rate development, and the actual total Contribution (Non -Federal Share) may differ from the amount listed here. 9 Template Version - 12/2019