HomeMy WebLinkAboutFD Agreement to Participate in a Medi-Cal Intergovernmental Transfer Cost Recovery Program____________________________________________________________________________________
FOR CITY CLERK ONLY
Council Meeting: November 20, 2023
Disposition: Authorized the City Manager to execute an agreement allowing the San Rafael Fire
Department to participate in a Medi-Cal Intergovernmental Transfer (IGT) program with the California
Department of Health Care Services (DHCS) for the service period of January 1, 2022 through
December 31, 2022
Agenda Item No: 4.d
Meeting Date: November 20, 2023
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Darin White, Fire Chief
Thomas Wong, Sr. Mgmt. Analyst II
City Manager Approval: ______________
TOPIC: AGREEMENT TO PARTICIPATE IN A MEDI-CAL INTERGOVERNMENTAL
TRANSFER COST RECOVERY PROGRAM
SUBJECT: AUTHORIZE THE CITY MANAGER TO EXECUTE AN AGREEMENT ALLOWING THE
SAN RAFAEL FIRE DEPARTMENT TO PARTICIPATE IN A MEDI-CAL
INTERGOVERNMENTAL TRANSFER (IGT) PROGRAM WITH THE CALIFORNIA
DEPARTMENT OF HEALTH CARE SERVICES (DHCS) FOR THE SERVICE PERIOD
OF JANUARY 1, 2022 THROUGH DECEMBER 31, 2022.
RECOMMENDATION:
Authorize the City Manager to execute an agreement allowing the San Rafael Fire Department to
participate in a Medi-Cal Intergovernmental Transfer (IGT) program with the California Department of
Health Care Services (DHCS) for the service period of January 1, 2022 through December 31, 2022.
EXECUTIVE SUMMARY:
The proposed agreement for participation in a Medi-Cal Intergovernmental Transfer (IGT) for the
service period of January 1, 2022 through December 31, 2022 represents the ninth year of the City’s
participation in the IGT program. The IGT program is administered the following year to allow for
statewide ambulance data to be calculated which sets the IGT rate for each agency. The program
assists the City in recovering costs associated with the provision of Emergency Medical Services (EMS)
to individuals who are covered by Medi-Cal. 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 far less than the actual cost to provide the service.
BACKGROUND:
Since 2006, 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 Voluntary Rate Range Intergovernmental Transfer 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 provide
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
health care/ambulance services to Medi-Cal managed care enrollees. This made eligible, public EMS
providers to receive increased reimbursements from Medi-Cal Managed Care Health Plan providers.
Under the IGT program, counties and other 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 EMS 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 HealthPlan of California.
To calculate the program’s total size and each agency’s share of the reimbursement, transport data is
collected from each agency on a quarterly basis. Once collected, letters of interest are sent to each
eligible agency to determine if they intend to participate. Using the letters of interest, DHCS then
calculates each agency’s share of the program based on the number of returned letters of interest.
Since Q4 2022 transport data is not submitted until Q1 2023, the calendar year 2022 program is
administered in 2023.
ANALYSIS:
Overview of IGT Program: The IGT program requires the transfer of eligible local dollars from the City
to DHCS. DHCS, in turn, uses transferred funds from local governments to increase monthly capitation
rates it previously paid Medi-Cal Managed Care Health Plan providers in the prior fiscal 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 to participate in the program, plus the federal match in return.
In September 2023, DHCS notified the City that a non-binding letter of interest must be submitted in
order for the City to participate in the program for the service period of January 1, 2022 through
December 31, 2022. Since the IGT program is voluntary, the non-binding letter allows DHCS to better
estimate how many agencies will participate, which sets the IGT contribution rate for each agency.
Staff submitted the non-binding letter of interest and has been working with DHCS to develop the
necessary agreement for participation. In October 2023, DHCS provided an estimated transfer amount
based on the returned LOIs from participating agencies with a standard agreement that all participating
agencies must sign (Attachment 1). DHCS is requesting the agreement be returned by November 24,
2023.
Transfer from the City to the State: Once 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
City Council’s approval, the City will transfer an estimated $273,667 to DHCS. Additionally, the City will
make a separate estimated payment of $54,733 (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 the service period of January 1, 2022, through December 31, 2022. If the State is
unable to use all the transferred funds to increase Plan rates, it will return any used funds and the
associated 20% administrative fee.
Payment to the City: Federal matching funds received by the City will be used to promote the well-
being of Partnership HealthPlan of California beneficiaries by maintaining the current service levels of
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3
the paramedic program. Although DHCS and Partnership HealthPlan of California have not provided
the City a revenue estimate at this time, the Fire Department expects to net roughly $450,000 for the
service period of January 1, 2022 through December 31, 2022 based on prior year revenues.
The calendar year 2021 program was temporarily put on hold by DHCS due to a request to revise rates
resulting in a review and a delay of the final payment until Q4 2023. Using the last full year’s payment,
FY 2019-2020, the City received $774,339, which consists of the original contributions and the federal
matched funds. When the 20% pre-paid administrative fee is considered, the resulting net revenue
received by the City was $458,222 for FY 2019-20. The City expects net revenue of a similar amount
for calendar year 2022, as discussed below.
FISCAL IMPACT:
The IGT will support the Emergency Medical Services Fund in recovering a greater portion of its
transport costs.
The DHCS agreement provides approximate transfer amounts based on information provided to the
City by Partnership HealthPlan of California, 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.
Time Period Funding
Source
Transfer
Amount to
DHCS
Admin
Fee to
DHCS
Estimated Funds
Returned to City
Estimated
Net New
Funds
2022 Calendar
Year Fund 210 $273,667 $54,733 $800,000 $471,600
The proposed funds to be transferred to the State will be allocated from the City’s Paramedic Services
Fund (210) and are expected to be transferred in January 2024.
OPTIONS:
1.Authorize the City Manager to execute an agreement allowing the San Rafael Fire Department
to participate in a Medi-Cal Intergovernmental Transfer (IGT) program with the California
Department of Health Care Services (DHCS) for the service period of January 1, 2022 through
December 31, 2022.
2.Direct staff to return with more information.
3.Take no action.
RECOMMENDED ACTION:
Authorize the City Manager to execute an agreement allowing the San Rafael Fire Department to
participate in a Medi-Cal Intergovernmental Transfer (IGT) program with the California Department of
Health Care Services (DHCS) for the service period of January 1, 2022 through December 31, 2022.
ATTACHMENTS:
1.IGT Agreement for 2022 Calendar Year with San Rafael Fire Department Allocation Estimates
CONTRACT # IGT-22-0015
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INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES (“DHCS”) and 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 period of January 1, 2022, through December 31, 2022 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-
CONTRACT # IGT-22-0015
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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 period of January 1, 2022, through
December 31, 2022 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 December 31, 2022. 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 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 Intergovernmental Transfer (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
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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 period of January 1, 2022, through December 31, 2022, 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
3.1 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 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
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20 percent fee. DHCS has determined that $ 0.00 of the transfer amounts, as shown in the table
below, 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 simultaneously with 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.
5. Notices. Any and all notices required, permitted, or desired to be given hereunder
by one party to the other shall either be sent via secure email or submitted in writing 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 as set forth below:
To the GOVERNMENTAL FUNDING ENTITY:
Thomas Wong, Senior Management Analyst II
1375 5th Ave.
San Rafael, CA 94901
(415) 458-5360
Thomas.wong@cityofsanrafael.org
CONTRACT # IGT-22-0015
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With copies to:
Insert CC Info as identified by Funding Entity
To DHCS:
Vivian Beeck
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., MS 4413
Sacramento, CA 95814
Vivian.Beeck@dhcs.ca.gov
Any required signature(s) on any documents must be in compliance with California Government
Code section 16.5 and any other applicable state or federal regulations.
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.
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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.
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 January 1, 2022, and shall expire as
of June 30, 2025 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.
CITY OF SAN RAFAEL FIRE DEPARTMENT:
By: Date: _______________________
(Funding Entity Signer)
CONTRACT # IGT-22-0015
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THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date: _______________________
David Bishop, Acting Division Chief, Capitated Rates Development Division
CONTRACT # IGT-22-0015
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Exhibit 1
* Note that Estimated Member Months are subject to variation, and the actual total Contribution
(Non-Federal Share) may differ from the amount listed here.
* FMAP is a weighted blend of multiple FMAPs.
Health Plan Funding Entity County Service Period Participation %
Partnership Health Plan
of California
City of San Rafael Fire
Department Regional 1/2022 - 12/2022 0.51%
Category of Aid SIS/UIS Contribution
PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child SIS 0.02$ 2,574,310 51,486$
Child UIS 0.03$ 75,498 2,265$
Adult SIS 0.04$ 1,136,355 45,454$
Adult UIS 0.11$ 124,071 13,648$
ACA Optional Expansion SIS 0.01$ 2,310,919 23,109$
ACA Optional Expansion UIS 0.08$ 160,059 12,805$
SPD SIS 0.12$ 446,077 53,529$
SPD UIS 0.29$ 21,750 6,308$
SPD/Full-Dual SIS 0.03$ 866,986 26,010$
SPD/Full-Dual UIS 0.08$ 1,419 114$
LTC (non-dual)SIS 0.58$ 1,167 677$
LTC (non-dual)UIS 1.20$ 384 461$
LTC/Full-Dual SIS 0.46$ 31,135 14,322$
LTC/Full-Dual UIS 0.98$ 31 30$
Whole Child Model SIS 0.23$ 98,296 22,608$
Whole Child Model UIS 0.42$ 2,002 841$
Est. FE Total 7,850,459 273,667$