HomeMy WebLinkAboutFD Medi-Cal Intergovernmental Transfer Cost Recovery Program Agreement____________________________________________________________________________________
FOR CITY CLERK ONLY
Council Meeting: September 3, 2024
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, 2023,
Through December 31, 2023
Agenda Item No: 4.g
Meeting Date: September 3, 2024
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Abe Roman, Fire Chief
Thomas Wong, Sr. Mgmt. Analyst II
City Manager Approval: ______________
TOPIC: MEDI-CAL INTERGOVERNMENTAL TRANSFER COST RECOVERY PROGRAM
AGREEMENT
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, 2023, THROUGH DECEMBER 31, 2023.
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, 2023, through December 31, 2023.
EXECUTIVE SUMMARY:
The proposed agreement for participation in a Medi-Cal Intergovernmental Transfer (IGT) for the
service period of January 1, 2023, through December 31, 2023, represents the tenth 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
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
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
health care/ambulance services to Medi-Cal managed care enrollees. This made public EMS providers
eligible 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 choose 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.
Transport data is collected from each agency on a quarterly basis to calculate the program's total size
and share of the reimbursement. 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 2023
transport data is not submitted until Q1 2024, the calendar year 2023 program is administered in 2024.
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 participating local government receives back
the funding it provided to participate in the program, plus the federal match in return.
In June 2024, 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, 2023, through December 31,
2023. 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 July 2024, DHCS provided an estimated transfer amount
based on the returned letters of interest from participating agencies with a standard agreement that all
participating agencies must sign (Attachment 1). DHCS is requesting the agreement be returned by
September 16, 2024.
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 $214,265 to DHCS. Additionally, the City will
make a separate estimated payment of $42,853 (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, 2023, through December 31, 2023. 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 the Partnership HealthPlan of California cannot provide
the City a revenue estimate until they receive all participants signed IGT Agreements. The Fire
Department expects to net roughly $452,000 for the service period of January 1, 2023, through
December 31, 2023, based on prior year revenues.
Using the most recent calendar year (CY) 2022 cycle, the City received $796,792, 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 $468,392 for FY 2023-24. The City
expects net revenue of a similar amount for calendar year 2023, as discussed below.
FISCAL IMPACT:
The IGT will support the Emergency Medical Services Fund in recovering a greater portion of its
ambulance 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
2023 Calendar
Year Fund 210 $214,265 $42,853 $710,000 $452,882
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 November 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, 2023, through
December 31, 2023.
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, 2023, through December 31, 2023.
ATTACHMENTS:
1.IGT Agreement for 2023 Calendar Year with San Rafael Fire Department Allocation Estimates
CONTRACT # IGT-23-0016
1
Template Version - 3/2024
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 (“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, 2023 through December 31, 2023 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-23-0016
2
Template Version - 3/2024
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, 2023 through
December 31, 2023 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, 2023. 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
CONTRACT # IGT-23-0016
3
Template Version - 3/2024
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, 2023 through December 31, 2023, 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
CONTRACT # IGT-23-0016
4
Template Version - 3/2024
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 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, Sr. Mgmt Analyst II
1375 5th Ave.
San Rafael, CA 94901
(415) 458-5360
Thomas.wong@cityofsanrafael.org
With copies to:
CONTRACT # IGT-23-0016
5
Template Version - 3/2024
Abraham Roman, Fire Chief
1375 5th Ave.
San Rafael, CA 94901
(415) 458-3306
abraham.roman@cityofsanrafael.org
Jason Hatfield, Battalion Chief
1375 5th Ave.
San Rafael, CA 94901
(415) 458-3368
jason.hatfield@cityofsanrafael.org
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
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.
CONTRACT # IGT-23-0016
6
Template Version - 3/2024
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. 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.
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, 2023 and shall expire as
of June 30, 2026 unless terminated earlier by mutual agreement of the parties.
CONTRACT # IGT-23-0016
7
Template Version - 3/2024
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)
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date: _______________________
David Bishop, Division Chief, Capitated Rates Development Division
CONTRACT # IGT-23-0016
8
Template Version - 3/2024
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 1/2023 - 12/2023 0.40%
Category of Aid SIS/UIS Contribution
PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Fe deral Share)
Child SIS 0.01$ 2,591,827 25,918$
Child UIS 0.01$ 97,541 975$
Adult SIS 0.04$ 1,198,291 47,932$
Adult UIS 0.03$ 165,873 4,976$
ACA Optional Expansion SIS 0.01$ 2,436,431 24,364$
ACA Optional Expansion UIS 0.01$ 216,291 2,163$
SPD SIS 0.11$ 439,967 48,396$
SPD UIS 0.09$ 30,489 2,744$
SPD/Full-Dual SIS 0.04$ 912,959 36,518$
SPD/Full-Dual UIS 0.02$ 2,680 54$
LTC SIS 0.11$ 1,081 119$
LTC UIS 0.09$ 372 33$
LTC/Full-Dual SIS 0.04$ 29,751 1,190$
LTC/Full-Dual UIS 0.02$ 27 1$
Whole Child Model SIS 0.19$ 98,440 18,704$
Whole Child Model UIS 0.08$ 2,227 178$
Est. FE Total 8,224,247 214,265$