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HomeMy WebLinkAboutFD Ambulance Service Cost RecoverySAN RAFAEL THE CITY WITH A MISSION Agenda Item No: 4.h Meeting Date: May 15, 2017 SAN RAFAEL CITY COUNCIL AGENDA REPORT Department: Fire P�- Prepared by: Christopher Gray City Manager Approval: Fire Chief TOPIC: Ambulance Service Cost Recovery SUBJECT: RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AUTHORIZING THE CITY MANAGER TO EXECUTE AGREEMENTS TO ALLOW THE SAN RAFAEL FIRE DEPARTMENT TO PARTICIPATE IN AN INTERGOVERNMENTAL TRANSFER WITH THE CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (DHCS) IN ORDER TO INCREASE THE DEPARTMENT'S REIMBURSEMENT FOR EMS AMBULANCE TRANSPORT SERVICES PROVIDED TO COUNTY HEALTH PLAN (PARTNERSHIP HEALTH PLAN) MEMBERS FOR FY 2015-2016 and FY 2016-2017. RECOMMENDATION: Adopt resolution authorizing the City Manager to execute agreements to allow the City of San Rafael Fire Department to participate in Intergovernmental Transfers with the California Department of Health Care Services for FY 2015-2016 and FY 2016-2017. EXECUTIVE SUMMARY: This request for the City Manager to execute agreements on behalf of the City for participation in two Medi -Cal rate range Intergovernmental Transfers (IGT) for rate years FY 2015-2016 and FY 2016-2017 represents the third and fourth years of the City's participation in the Intergovernmental Transfer Program that assists the City in recovering costs association with provision of Emergency Medical Services to the Managed Medi -Cal population. BACKGROUND: Since 2006, the Department of Health Care Services (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 program, called a voluntary rate range Intergovernmental Transfer (IGT) 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 provides health care services to Medi -Cal managed care enrollees making them eligible to receive increased reimbursements from Med-Cal Managed Care Health Plan Providers. FOR CITY CLERK ONLY File No.: 9-3-31 Council Meeting: 05/15/2017 Disposition: Resolution 14322 SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2 Under the IGT program, counties and other political subdivisions or 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 Health Plan of California (PHC). PHC has agreed to participate in the IGT program along with its regional partners, San Rafael Fire Department, Marin County Health and Human Services, Marin General Hospital, Novato Fire District and Southern Marin Fire District. This year, intergovernmental transfers for FY 2015-2016 and FY 2016-2017 will be initiated at the same time. ANALYSIS: Overview of IGT Process: The IGT program requires the transfer of eligible local dollars from the City to the DHCS. DHCS in turn uses transferred funds from local governments to increase monthly capitation rates it 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, plus the federal match in return. PHC began discussions with DHCS in January of 2017 in order to notify the State of the County's interest in participating in the IGT program. PHC then notified the San Rafael Fire Department that a non-binding letter of interest must be submitted. The Department submitted the non-binding letter of interest and has been working with both DHCS and PHC in developing the necessary agreements for participation. 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 approximately $125 per emergency ambulance transport, which is less than 10% of the actual cost to provide the service. State DHCS Rate Increase Contract: Based on the participating agencies' signed contracts to transfer funds to DHCS, the state will contact PHC to increase its per member, per month capitation rates. The Plan's rate will be increased to the highest actuarially sound rate. Transfer from the Department to the State: Once the 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 Council's approval, the Fire Department projects that it will transfer $246,546 and $301,458 to DHCS for FY 2015-2016 and FY 2016-2017. Additionally, the Department will make separate payments of approximately $49,309 and $60,292 (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 both FY 15-16 and FY 16-17. If the State is unable to use all of the transferred funds to increase Plan rates, it will return any used funds and the associated 20% administrative fee. Payment to the Fire Department: The San Rafael Fire Department should receive approximately $504,144 and $627,487 which are comprised 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 Fire Department will be approximately $208,289 for FY 15-16 and $265,738 for FY 16-17. New Federal matching funds received by the Fire Department will be used to promote the well-being of PHC beneficiaries by maintaining or improving the current service levels of the paramedic program. The rate range IGT will be implemented through execution of three contracts; two with the DHCS and one with PHC. These documents spell out the obligations of each entity in regard to the transfer of local government funds, the use of funds by DHCS, the payment of funds to PHC, and the treatment of payments by PHC. Before any funds are transferred, all the contracts must be signed by the participating agencies and the Plan rate increases must be approved by the federal government. The specific contract documents are for Rate Years SAN RAFAEL CITY COUNCIL AGENDA REPORT / Paae: 3 2015-2016 and 2016-2017 need to be returned to DHCS by May 31St and due to the anticipated short turnaround time, staff is recommending that the City Manager be given the authority to negotiate and sign these agreements as well as any related documents. FISCAL IMPACT: The IGT will support the Emergency Medical Services Fund in recovering a greater portion of its transport costs. The Department requests City Council approval to pursue participation in an IGT to secure additional federal matching funds to support health care services to the Medi -Cal eligible population. Exhibits I & II provide approximate transfer amounts based on information provided to the department by PHC, the County's Medi -Cal Managed Health Care Plan Provider. A summary of the amount the City will transfer to DHCS and receive back through participation in this program is outlined below. Fiscal Year Transfer Amount Admin Fee Funds Returned by Net New Funds PHC FY 15-16 $246,546 $49,309 $504,144 $208,289 FY 16-17 $301,458 $60,292 $627,487 $265,738 The proposed funds to be transferred to the State will be allocated from the Department's Emergency Medical Services Fund and will be wired to the DHCS as early as June 2017 or as late as July 2018. The funds will return to the Department as enhanced Medi -Cal payments six to eight weeks later. OPTIONS: 1. Adopt resolution authorizing the City Manager to execute agreements to allow the City of San Rafael Fire Department to participate in Intergovernmental Transfers with the California Department of Health Care Services for FY 2015-2016 and FY 2016-2017. 2. Adopt resolution with modifications authorizing the City Manager to execute agreements to allow the City of San Rafael Fire Department to participate in Intergovernmental Transfers with the California Department of Health Care Services for FY 2015-2016 and FY 2016-2017. 3. Direct staff to return with more information. 4. Take no action. RECOMMENDED ACTION: Adopt Resolution Authorizing the City Manager to execute agreements to allow the City of San Rafael Fire Department to participate in an Intergovernmental Transfer with the California Department of Health Care Services, in a form to be approved by the City Attorney. ATTACHMENTS: 1. Resolution 2. Exhibit I Marin County Cost Allocation Estimates FY 2015-2016 3. Exhibit II Marin County Cost Allocation Estimates FY 2016-2017 RESOLUTION NO. 14322 RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AUTHORIZING THE CITY MANAGER TO EXECUTE AGREEMENTS TO ALLOW THE SAN RAFAEL FIRE DEPARTMENT TO PARTICIPATE IN AN INTERGOVERNMENTAL TRANSFER WITH THE CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (DHCS) IN ORDER TO INCREASE THE DEPARTMENT'S REIMBURSEMENT FOR EMS AMBULANCE TRANSPORT SERVICES PROVIDED TO COUNTY HEALTH PLAN (PARTNERSHIP HEALTH PLAN) MEMBERS FOR FY 2015-2016 and FY 2016-2017. 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 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, that the City Council does hereby authorize the San Rafael Fire Department 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 members for FY 2015-2016 and FY 2016-2017. BE IT FURTHER RESOLVED, that the City Council hereby authorizes the City Manager to execute agreements with PHC and DHCS for the San Rafael Fire Department's participation in this program, subject to final approval as to form by the City Attorney. BE IT FURTHER RESOLVED, that the City Council does hereby authorize the transfer of funds to DHCS pursuant to such agreements, 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 June 30, 2015 through July 1, 2016 and June 30, 2016 through July 1, 2017. I, ESTHER C. BEIRNE, 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 15th day of May, 2017, by the following vote, to wit: AYES: COUNCILMEMBERS: Bushey, Colin, Gamblin, McCullough & Mayor Phillips NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None ESTHER C. BEIRNE, City Clerk Partnership HealthPlan of California DRAFT CONTRIBUTION ALLOCATION ESTIMATES IN THE ORIGINAL HEALTH PLAN REGION - FY 2015/16 7 Column B Column C Column D Column E Column G Column H Column I Column J $208,289 Costs for Revenues 2015-16 Transfer to DHCS Admin PHC's payment Net new funds 3 Partnership from PHC Unreimb. fund the IGT Fee to provider in PHC's 3 Services Costs 20% of total funds payment to Column G Provider 4 MARIN headroom: $4,091,940 Max provider contribution: $2,001,115 5 Marin Cnty HHS & Cnty Fire $2,479,862 $102,992 $2,376,870 $652,865 $130,573 $1,334,997 $551,560 6 Novato Fire $425,997 $44,360 $381,637 $104,826 $20,965 $214,351 $88,560 7 San Rafael Fire $956,665 $59,071 $897,594 $246,546 $49,309 $504,144 $208,289 8 Southern Marin Fire $582,883 $23,196 $559,687 $153,732 $30,746 $314,355 $129,877 charge based 9 Marin General Hospital $3,069,627 $0 $3,069,627 $843,147 $168,629 $1,724,093 $712,316 10 Subtotal $7,515,034 $229,619 $7,285,415 $2,001,115 $400,223 $4,091,940 $1,690,602 Partnership HealthPlan of California DRAFT CONTRIBUTION ALLOCATION ESTIMATES IN THE ORIGINAL HEALTH PLAN REGION - FY 16/17 Column B Column C Column D Column E Column G Column H Column I Column J Costs for Revenues 2015-16 Transfer to DHCS Admin PHC's payment Net new funds 3 Partnership from PHC Unreimb. fund the IGT Fee to provider in PHC's 3 Services Costs 20% of total funds payment to o Column G Provider 4 MARIN headroom: $5,093,063 Max provider contribution: $2,446,812 5 Marin Cnty HHS & Cnty Fire $2,479,862 $102,992 $2,376,870 $798,274 $159,655 $1,661,614 $703,686 6 Novato Fire $425,997 $44,360 $381,637 $128,173 $25,635 $266,794 $112,986 San Rafael Fire $956,665 $59,071 $897,594 $301,458 $60,292 $627,487 $265,738 Southern Marin Fire $582,883 $23,196 $559,687 $187,971 $37,594 $391,264 $165,698 charge based Marin General Hospital $3,069,627 $0 $3,069,627 $1,030,936 $206,187 $2,145,904 $908,781 10 Subtotal $7,515,034 $229,619 $7,285,415 $2,446,812 $489,362 $5,093,063 $2,156,889 CONTRACT # 16-93710 INTERGOVERNMENTAL TRANSFER ASSESSMENT FEE This Agreement is entered into between the CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES ("State DHCS") and the City of San Rafael (GOVERNMENTAL FUNDING ENTITY) with respect to the matters set forth below. RECITALS A. This Agreement is made pursuant to the authority of Welfare & Institutions Code, section 14301.4. THEREFORE, the parties agree as follows: AGREEMENT 1. Transfer of Public Funds 1.1 GOVERNMENTAL FUNDING ENTITY shall make Intergovernmental Transfer(s) ("IGTs") to State DHCS pursuant to section 14164 of the Welfare and Institutions Code and paragraph 1.1 of the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds contract number 16-93679, to be used as a portion of the non-federal share of actuarially sound Medi -Cal managed care rate range capitation increases ("non-federal share IGT") to HEALTH PLAN (Partnership HealthPlan of California) for the periods of July 1, 2015 to June 30, 2016 and July 1, 2016 to June 30, 2017. 1.2 The parties acknowledge that State DHCS will obtain any necessary approvals from the Centers for Medicare and Medicaid Services ("CMS") pertaining to the acceptance of non- federal share IGTs and the payment of non-federal share IGT related rate range capitation increases to HEALTH PLAN. 2. Intergovernmental Transfer Assessment Fee CONTRACT # 16-93710 2.1 The State DHCS shall, upon acceptance of non-federal share IGTs pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in paragraph 1 of this Agreement, exercise its authority under section 14301.4 of the Welfare and Institutions Code to assess a 20 -percent assessment fee on the entire amount of the non-federal share IGTs to reimburse State DHCS for the administrative costs of operating the IGT program pursuant to this section and for the support of the Medi -Cal program. 2.2 The funds subject to the 20 -percent assessment fee shall be limited to non-federal share IGTs made by the transferring entity, GOVERNMENTAL FUNDING ENTITY, pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in paragraph 1 of this Agreement. 2.3 The 20 -percent fee will be assessed on the entire amount of the non-federal share IGTs pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in paragraph 1 of this Agreement, and will be made in addition to, and transferred separately from, the transfer of funds pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds. 2.4 The 20 -percent assessment fee pursuant to this Agreement is non-refundable and shall be wired to State DHCS separately from, and simultaneous to, the non-federal share IGTs pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in paragraph 1 of this Agreement. However, if any portion of the non-federal share IGTs is not expended for the specified rate increases stated in paragraph 2.2 of the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, DHCS shall return a proportionate amount of the 20 -percent assessment fee to the GOVERNMENTAL FUNDING ENTITY. 2 CONTRACT 4 16-93710 Other Provisions 3.1 This Agreement contains the entire Agreement between the parties with respect to the 20 -percent assessment fee on non-federal share IGTs pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, and as described in paragraph 1, and supersedes any previous or contemporaneous oral or written proposals, statements, discussions, negotiations or other agreements between the GOVERNMENTAL FUNDING ENTITY and State DHCS. 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. One or more other agreements may exist between the parties regarding such other matters, and other agreements may be entered into in the future. This Agreement shall not modify the terms of any other agreement between the parties. 3.2 Time is of the essence in this Agreement. 3.3 Each party hereby represents that the person(s) executing this Agreement on its behalf is duly authorized to do so. 4. State Authority. Except as expressly provided herein, nothing in this Agreement shall be construed to limit, restrict, or modify State DHCS' powers, authorities, and duties under federal and state law and regulations. 5. Approval. This Agreement is of no force and effect until signed by the parties. CONTRACT 4 16-93710 SIGNATURES IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of the last signature below. THE CITY OF SAN RAFAEL By: Date: S--16 I Jim chutz, City Manager, City of San Rafael 1400 Fifth Avenue San Rafael, CA 94901 A(pJproved As To Form: 0 S&jW�-,-4,1ZFC City Attorney, City f Sanafael THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES: By: Date: Jennifer Lopez, Acting Division Chief, Capitated Rates Development Division 4 CONTRACT # 16-93679 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 (GOVERNMENTAL FUNDING ENTITY) with respect to the matters set forth below. RECITALS A. This Agreement is made pursuant to the authority of Welfare & Institutions Code, sections 14164 and 14301.4. B. The Partnership HealthPlan of California (HEALTH PLAN) is a County Organized Ilealth System formed pursuant to Welfare and Institutions Code section 14087.54 and County Code Chapter 7.58, County Code Chapter 2.45, County Code Chapter 2, Title 2, and County Code Chapter 34. HEALTH PLAN is a party to a Medi -Cal managed care contract with DHCS, entered into pursuant to Welfare and Institutions Code section 14087.3, under which HEALTH PLAN arranges and pays for the provision of covered Medi -Cal health care services to eligible Medi -Cal members residing in the County. THEREFORE, the parties agree as follows: AGREEMENT 1. Transfer of Public Funds 1.1 The GOVERNMENT FUNDING ENTITY shall transfer funds to DHCS pursuant to sections 14164 and 14301.4 of the Welfare and Institutions Code, up to a maximum total amount of Two Hundred Thirty Six Thousand, Nine Hundred Seventy Five Dollars ($236,975) for the period of July 1, 2015 through June 30, 2016, and a maximum total amount of Two Hundred Fifty One Thousand, Nine Hundred Seventy Two Dollars ($251,972) for the period of July 1, 2016 through June 30, 2017, to be used solely as a portion of the nonfederal share of actuarially sound Medi -Cal managed care capitation rate increases for HEALTH PLAN for the periods of July 1, 2015 through June 30, 2016, and July 1, 2016 CONTRACT # 16-93679 through June 30, 2017 as described in section 2.2 below. The funds shall be transferred in accordance with a mutually agreed upon schedule between the GOVERNMENTAL FUNDING ENTITY and DHCS, in the amounts specified therein. 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. For transferring units of government that are also direct service providers, 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. 2. Acceptance and Use of Transferred Funds by DHCS 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 transfers ("IGTs"), to use for the purpose set forth in section 2.2 below. 2.2 The funds transferred by the GOVERNMENTAL FUNDING ENTITY pursuant to this Agreement shall be used to fund a portion of the nonfederal share of increases in Medi -Cal managed care actuarially sound capitation rates described in paragraph (4) of subdivision (b) of section 14301.4 of the Welfare and Institutions Code and shall be paid, together with the related federal financial participation, by DHCS to HEALTH PLAN as part of HEALTH PLAN'S capitation rates for the periods of July 1, 2015 through June 30, 2016 and July 1, 2016 through June 30, 2017. The rate increases paid under section 2.2 shall be used for payments related to Medi -Cal services rendered to Medi -Cal 2 CONTRACT # 16-93679 beneficiaries. The rate increases paid under this section 2.2 shall be in addition to, and shall not replace or supplant, all other amounts paid or payable by DHCS or other State agencies to HEALTH PLAN. 2.3 DHCS shall seek federal financial participation for the rate increases specified in section 2.2 to the full extent permitted by federal law. 2.4 The parties acknowledge the State DHCS will obtain any necessary approvals from the Centers for Medicare and Medicaid Services prior to the payment of any rate increase pursuant to section 2.2. 2.5 The parties agree that none of these funds, either GOVERNMENTAL FUNDING ENTITY or federal matching funds will be recycled back to the GOVERMENTAL 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 Agreement and their provider agreement constitute patient care revenues. 2.6 Within One Hundred Twenty (120) calendar days of the execution of this Agreement, DHCS shall advise the GOVERNMENTAL FUNDING ENTITY and HEALTH PLAN of the amount of the Medi -Cal managed care capitation rate increases that DHCS paid to HEALTH PLAN during the applicable rate year involving any funding under the terms of this Agreement. 2.7 If any portion of the funds transferred by the GOVERNMENTAL FUNDING ENTITY pursuant to this Agreement is not expended for the specified rate increases under Section 2.2, DHCS shall return the unexpended funds to the GOVERNMENTAL FUNDING ENTITY. Amendments 3.1 No amendment or modification to this Agreement shall be binding on either party unless made in writing and executed by both parties. 3 CONTRACT # 16-93679 3.2 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. 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: Chris Gray Fire Chief The City of San Rafael Fire Department 1600 Los Gamos Drive Suite #345 San Rafael, Ca 94903 chris.arav a,citvofsanrafael.org With copies to: To DHCS: Jim Schutz City Manager City of San Rafael 14005 th Ave San Rafael, Ca 94901 iim.schutz a,citvofsanrafael.org Carolyn Stewart Senior Director of Financial Analysis Partnership HealthPlan of California 4665 Business Center Drive Fairfield, CA 94534 cstewart@partnership.org Sandra Dixon California Department of Health Care Services 4 CONTRACT # 16-93679 Capitated Rates Development Division 1501 Capitol Ave., Suite 71-4002 MS 4413 Sacramento, CA 95814 Sandra.Dixon@dhcs.ca.gov 5. Other Provisions 5.1 This Agreement contains the entire Agreement between the parties with respect to the Medi -Cal rate increases for HEALTH PLAN described in section 2.2 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. 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. One or more other agreements already exist between the parties regarding such other matters, and other agreements may be entered into in the future. This Agreement shall not modify the terms of any other agreement between the parties. 5.2 The nonenforcement 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. Agreement. 5.3 Section 2 of this Agreement shall survive the expiration or termination of this 5.4 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. 5.5 Time is of the essence in this Agreement. 5 CONTRACT # 16-93679 5.6 Each party hereby represents that the person(s) executing this Agreement on its behalf is duly authorized to do so. 6. State Authoritv. 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. 7. Approval. This Agreement is of no force and effect until signed by the parties. 8. Term. This Agreement shall be effective as of July 1, 2015 and shall expire as of June 30, 2019 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 By: INS. Date: 46 ( 7 im S hutz, City rager,ty of San Rafael Approved As To Form: City Attorney, City of an Ra el THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES: IM Jennifer Lopez, Acting Division Chief, Capitated Rates Development Division Date: 6 HEAL TH PLAN-PROVIDER AGREEMENT PARTNERSHIP HEALTHPLAN OF CALIFORNIA & CITY OF SAN RAFAEL AMENDMENT 3 This Amendment is made this i/AJ+;fay of A-pn -/(month/year) by and between PARTNERSHIP HEAL THPLAN OF CALIFORNIA, a County 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 q-3-3 \ 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. If the PLAN receives any capitation rate increases for MMCS taxes based on the IGT MMCRRIs, 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. 2 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 form 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 normally 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 lOT Payments, PROVIDER shall use the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT 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 lOT 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, ifany, 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 IGT 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 IGT Payments received, but not used. These retained PROVIDER funds may be commingled with other GOVERNMENTAL FUNDING ENTITY funds for cash management purposes provided 3 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 MMCRRIs 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 ofa 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 4 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: rrQ~a~I8011 By: Elizabeth Gibboney, CEO , Partnership HealthPlan of California PROVIDER: __ -F~~~+==-~-+ ________ __ Date: 5--16 -! 7 By: Jim Schutz, . Manager, City 0 1400 Fifth Avenue San Rafael, CA 94901 Approved As To Form: ~/~(1~~~e City Attorney, cTt)fOfSIlRara I 5 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: mailto❑ FPPC: Check if Contractor/Consultant must file Form 700 StepRESPONSIBLE I DEPARTMENT 1 1 Project Manager 2 City Attorney 3 1 Project Manager 4 i i E DESCRIPTION a. Email PINS Introductory Notice to Contractor b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael.org a. Review, revise, and comment on draft agreement and return to Project Manager b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor Forward three (3) originals of final agreement to contractor for their signature Project Manager When necessary, * contractor -signed agreement agendized for Council approval *PSA > $20,000; or Purchase > $35,000; or Public Works Contract > $125,000 Date of Council approval PRINT CONTINUE ROUTING PROCESS WITH HARD COPY Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form City Attorney Review and approve hard copy of signed agreement City Attorney Review and approve insurance in PINS, and bonds (for Public Works Contracts) City Manager/ Mayor Agreement executed by Council authorized official City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager COMPLETED DATE Not Needed 5/1/2017 5/8/2017 5/8/2017 We need to sign first and we need five signed originals ❑ N/A Or 5/15/2017 5/8/2017 REVIEWER Check/Initial Z LAG Z LAG N/A DF ROUTING SLIP / APPROVAL FORM INSTRUCTIONS: Use this cover sheet with each submittal of a staff report before approval by the City Council. Save staff report (including this cover sheet) along with all related attachments in the Team Drive (T:) --> CITY COUNCIL AGENDA ITEMS 4 AGENDA ITEM APPROVAL PROCESS 4 [DEPT - AGENDA TOPIC] Agenda Item # Date of Meeting: 5/15/2017 From: Chris Gray/Danielle Ferrigno Department: Finance Date: 5/15/2017 Topic: IGT Subject: RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AUTHORIZING THE CITY MANAGER TO EXECUTE AGREEMENTS TO ALLOW THE SAN RAFAEL FIRE DEPARTMENT TO PARTICIPATE IN AN INTERGOVERNMENTAL TRANSFER WITH THE CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (DHCS) IN ORDER TO INCREASE THE DEPARTMENT'S REIMBURSEMENT FOR EMS AMBULANCE TRANSPORT SERVICES PROVIDED TO COUNTY HEALTH PLAN (PARTNERSHIP HEALTH PLAN) MEMBERS FOR FY 2015-2016 and 2016-2017. Type: ® Resolution ❑ Ordinance ❑ Professional Services Agreement ❑ Other: APPROVALS ® Finance Director Remarks: MM - approved 5/8/2017 ® City Attorney Remarks: LG -Approved 5/8/17. This report might benefit from a "Plain English" executive summary. ❑ Author, review and accept City Attorney / Finance changes Remarks: DF- Approved 5/9/17 with the addition of a "Plain English" executive summary ® City Manager Remarks: FOR CITY CLERK ONLY File No.: Council Meeting: Disposition: