HomeMy WebLinkAboutFD Ambulance Service Cost Recovery Agreement____________________________________________________________________________________
FOR CITY CLERK ONLY
Council Meeting: 06/02/2025
Disposition: Resolution 15409
Agenda Item No: 4.e
Meeting Date: June 2, 2025
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Abe Roman, Fire Chief
Thomas Wong, Sr. Mgmt. Analyst II
City Manager Approval: ______________
TOPIC: AMBULANCE SERVICE COST RECOVERY AGREEMENT
SUBJECT: RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE AGREEMENTS
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) AND KAISER FOR THE
SERVICE PERIOD OF JANUARY 1, 2024 THROUGH DECEMBER 31, 2024
EXECUTIVE SUMMARY:
The proposed agreement for participation in a Medi-Cal Intergovernmental Transfer (IGT) for the
service period of January 1, 2024, through December 31, 2024, represents the 11th 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.
RECOMMENDATION:
Staff recommends that the City Council adopt the resolution authorizing the City Manager to execute
agreements 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) and Kaiser for
the service period of January 1, 2024, through December 31, 2024.
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 access 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
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
care/ambulance services to Medi-Cal managed care enrollees. This made public EMS providers eligible
for 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 to support the Medi-Cal program. These funds are used to match 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 the
Partnership Health Plan of California.
Transport data is collected from each agency quarterly 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 2024 transport data is not
submitted until Q1 2025, the calendar year 2024 program is administered in 2025.
This year, for the first time, Kaiser is administering their own IGT with DHCS. Kaiser and DHCS are
working together to collect the revenues concurrently and through DHCS, but separate agreements
need to be signed to participate in each program.
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 in local government receives
back the funding it provided to participate in the program, plus the federal match in return.
In February 2025, DHCS and Kaiser notified the City that non-binding letters of interest must be
submitted to the City to participate in the program for the service period of January 1, 2024, through
December 31, 2024. Since the IGT program is voluntary, the non-binding letter allows DHCS and
Kaiser to better estimate how many agencies will participate, which sets the IGT contribution rate for
each agency.
Staff submitted the non-binding letters of interest and have been working with DHCS and Kaiser to
develop the necessary agreement for participation. In May 2025, DHCS provided an estimated transfer
amount for both DHCS and Kaiser 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 August 1, 2025. Kaiser’s agreement is forthcoming but must be signed
around the same time.
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 $366,163 to DHCS. Additionally, the City will
make a separate estimated payment of $73,228 (20%) to DHCS and Kaiser 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, 2024, through December 31, 2024. If the State is
unable to use all the transferred funds to increase plan rates, it will return any used funds and the
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3
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
the paramedic program. Although DHCS, Kaiser, 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 $611,716 for the service period of January 1, 2024, through
December 31, 2024, based on prior year revenues.
FISCAL IMPACT:
The IGT will support the Emergency Medical Services Fund by recovering a greater portion of its
ambulance transport costs.
The DHCS agreement provides approximate transfer amounts based on information provided to the
City by Kaiser and 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
2024
Calendar Year Fund 210 $366,163 $73,228 $1,051,107 $611,716
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 2025.
OPTIONS:
1. Authorize the City Manager to execute agreements 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) and Kaiser for the service period of January 1,
2024, through December 31, 2024.
2. Direct staff to return with more information.
3. Take no action.
RECOMMENDED ACTION:
Staff recommends that the City Council adopt the resolution authorizing the City Manager to execute
agreements 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) and Kaiser for
the service period of January 1, 2024, through December 31, 2024.
ATTACHMENTS:
1. Resolution
2. IGT Agreement for 2024 Calendar Year with San Rafael Fire Department Allocation Estimates
1
RESOLUTION NO.
RESOLUTION OF THE SAN RAFAEL CITY COUNCIL AUTHORIZING THE CITY
MANAGER TO EXECUTE AGREEMENTS 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) AND KAISER FOR THE SERVICE PERIOD OF JANUARY
1, 2024, THROUGH DECEMBER 31, 2024
WHEREAS, the City of San Rafael, through its Fire Department, regularly provides
emergency ambulance transport to persons who are Medi-Cal patients enrolled in
managed care plans; and
WHEREAS, the City participates in various governmental programs that provide
reimbursement of costs incurred in providing such emergency services to Medi-Cal
patients; and
WHEREAS, pursuant to the authority of Welfare & Institutions Code sections
14164 and 14301.4, since 2006 the California Department of Health Care Services
(DHCS) has been offering a voluntary rate range Intergovernmental Transfer Program to
allow healthcare providers such as the City of San Rafael Fire Department to access
federal matching funds for reimbursement through their Medi-Cal Managed Care Health
Plan Providers; and
WHEREAS, the City may pursue an Intergovernmental Transfer to DHCS and
Kaiser through its Medi-Cal Managed Care Health Plan Provider, Partnership Health Plan
of California (PHC); and
WHEREAS, by participating in the Intergovernmental Transfer Program, the City
will receive reimbursements for a larger proportion of its actual costs for providing
emergency ambulance transport to Medi-Cal patients enrolled in managed care plans;
and
WHEREAS, under the Intergovernmental Transfer Program, the funds shall be
transferred in accordance with a mutually agreed-upon schedule between the City of San
Rafael and DHCS;
NOW, THEREFORE, BE IT RESOLVED, by the San Rafael City Council as
follows:
1. The San Rafael Fire Department is hereby authorized to participate in an
Intergovernmental Transfer (IGT) with the California Department of Health
Care Services (DHCS) in order to increase the Department’s reimbursement
for EMS ambulance transport services provided to Partnership Health Plan of
California (PHC) members for the service period of January 1, 2024 through
December 31, 2024.
2
2. The City Manager is authorized to execute two separate required
Intergovernmental Agreements Regarding Transfer of Public Funds with DHCS
and Kaiser subject to final approval as to form by the City Attorney.
3. The City Council hereby authorizes the transfer of funds to DHCS pursuant to
such agreement, in an amount approved by the City Manager and in
accordance with a mutually agreed upon schedule, to be used solely as a
portion of the non-federal share of actuarially-sound Medi-Cal managed care
capitation rate increases for the Partnership Health Care period of January 1,
2024 through December 31, 2024.
I, LINDSAY LARA, Clerk of the City of San Rafael, hereby certify that the foregoing
Resolution was duly and regularly introduced and adopted at a regular meeting of the City
Council of said City held on Monday, the 2nd day of June 2025 by the following vote, to
wit:
AYES: COUNCILMEMBERS:
NOES: COUNCILMEMBERS:
ABSENT: COUNCILMEMBERS:
_________________
Lindsay Lara, City Clerk
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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 (“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, 2024 through December 31, 2024 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-
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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, 2024 through
December 31, 2024 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, 2024. 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, 2024 through December 31, 2024, 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 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
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1375 5th Ave.
San Rafael, CA 94901
(415) 458-5360
Thomas.wong@cityofsanrafael.org
With copies to:
Abraham Roman, Fire Chief
1375 5th Ave.
San Rafael, CA 94901
(415) 458-3306
abraham.roman@cityofsanrafael.org
Jason Hatfield, EMS Battalion Chief
1375 5th Ave.
San Rafael, CA 94901
(415) 458-3306
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-
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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. 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, 2024 and shall expire as
of June 30, 2027 unless terminated earlier by mutual agreement of the parties.
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SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on
the date of the last signature below.
CITY OF SAN RAFAEL:
By: Date: _______________________
Cristine Alilovich, City Manager
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date: _______________________
Authorized Representative, Department of Health Care Services
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Exhibit 1
Health Plan Funding Entity Rating Region Service Period Participation %
Partnership Health Plan
of California City of San Rafael North Bay 1/2024 - 12/2024 0.68%
Category of Aid SIS/UIS Contribution
PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child SIS 0.03$ 1,183,773 35,513$
Child UIS 0.01$ 101,234 1,012$
Adult SIS 0.08$ 402,627 32,210$
Adult UIS 0.05$ 277,256 13,863$
Adult Expansion SIS 0.01$ 1,076,570 10,766$
Adult Expansion UIS 0.01$ 303,621 3,036$
SPD SIS 0.25$ 201,658 50,415$
SPD UIS 0.13$ 31,151 4,050$
SPD Dual SIS 0.10$ 433,986 43,399$
SPD Dual UIS 0.02$ 4,914 98$
LTC SIS 0.24$ 934 224$
LTC UIS 0.13$ 365 47$
LTC Dual SIS 0.10$ 16,535 1,654$
LTC Dual UIS 0.02$ 51 1$
WCM SIS 0.28$ 41,744 11,688$
WCM UIS 0.16$ 1,792 287$
Est. FE Total 4,078,211 208,263$
Health Plan Funding Entity Rating Region Service Period Participation %
Kaiser Foundation Health
Plan City of San Rafael North Bay 1/2024 - 12/2024 2.71%
Category of Aid SIS/UIS Contribution
PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child SIS 0.12$ 385,112 46,213$
Child UIS 0.04$ 2,821 113$
Adult SIS 0.30$ 153,903 46,171$
Adult UIS 0.16$ 13,612 2,178$
Adult Expansion SIS -$ 281,499 -$
Adult Expansion UIS -$ 15,737 -$
SPD SIS 0.65$ 37,230 24,200$
SPD UIS 0.50$ 706 353$
SPD Dual SIS 0.17$ 88,064 14,971$
SPD Dual UIS 0.09$ 440 40$
LTC SIS 4.93$ 19 94$
LTC UIS -$ - -$
LTC Dual SIS 4.05$ 999 4,046$
LTC Dual UIS 0.18$ 1 -$
WCM SIS 1.14$ 17,014 19,396$
WCM UIS 0.71$ 138 98$
Est. FE Total 997,295 157,873$
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* 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.