HomeMy WebLinkAboutFD 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
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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.
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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
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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
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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
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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: 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