HomeMy WebLinkAboutFD Ambulance Service Cost Recovery____________________________________________________________________________________
FOR CITY CLERK ONLY
File No.: 4-3-713 (DHCS); 4-3-714 (PHP)
Council Meeting: 6/17/2019
Disposition: Resolution 14684
Agenda Item No: 4.f
Meeting Date: June 17, 2019
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Fire
Prepared by: Christopher Gray
Fire Chief
City Manager Approval: ______________
TOPIC: Ambulance Service Cost Recovery
SUBJECT: RESOLUTION 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
FISCAL YEAR 2018-2019.
RECOMMENDATION:
Adopt a 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 Fiscal Year (FY) 2018-2019.
EXECUTIVE SUMMARY:
This request for the City Manager to execute agreements on behalf of the City for participation in a
Medi-Cal rate range Intergovernmental Transfer (IGT) for rate year FY 2018-2019 represents the sixth
year 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 provide health care services to
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2
Medi-Cal managed care enrollees, to make these EMS providers eligible to receive increased
reimbursements from Med-Cal Managed Care Health Plan Providers.
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 HealthPlan of California (PHC). PHC has agreed to participate in
the IGT program along with its regional partners: the San Rafael Fire Department, Marin County Health
and Human Services, Marin General Hospital, Novato Fire Protection District, and Southern Marin Fire
District.
ANALYSIS:
Overview of IGT Process: 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 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 August 2018 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. In May 2019, DHCS provided the Department with an estimated transfer amount and
timeline for the FY 2018-2019 rate range program.
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 City Council’s approval, the Fire Department will transfer $285,351 to DHCS for FY
2018-2019. Additionally, the Department will make a separate payment of $57,070 (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 FY 2018-2019. 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.
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3
Payment to the Fire Department: The San Rafael Fire Department expects to receive approximately
$599,490 for FY 2018-19, an amount that is comprised of the original contributions and the federal
matched funds. This estimated amount is based on an average of the past two IGT payments received
by the City. When the 20% pre-paid administrative fee is considered, the resulting net revenue received
by the Fire Department is expected to be approximately $257,069 for FY 2018-19.
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 separate contracts with the DHCS and
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 for Rate Year 2018-2019 need to be returned to DHCS by July 31, 2019.
On May 17, 2019, the Department received an agreement from DHCS for the City Manager’s signature;
this is included as Attachment 2. On June 11, 2019, the City received a proposed agreement from
PHC; this is included as Attachment 3. Staff is recommending that the City Manager be given the
authority to sign these agreements as well as any related documents in the form approved by the City
Attorney.
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.
Attachment 4 provides 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 expects to transfer to DHCS and receive back through participation in this program is outlined
below.
Fiscal Year Funding
Source Transfer
Amount
Admin
Fee
Funds Returned
by PHC
Net New
Funds
FY 2018-2019 Fund 210 $285,351 $57,070 $599,490 $257,069
The proposed funds to be transferred to the State will be allocated from the Department’s Emergency
Medical Services Fund and are expected to be transferred in November 2019. The funds will return to
the Department as enhanced Medi-Cal payments approximately six to eight weeks later.
OPTIONS:
1. Adopt the resolution as presented.
2. Direct staff to return with more information.
3. Take no action.
RECOMMENDED ACTION:
Adopt a 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.
SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 4
ATTACHMENTS:
1. Resolution
2. IGT Agreement for FY 2018-2019
3. Health Plan-Provider Agreement for FY 2018-2019
4. San Rafael Fire Department Allocation Estimates FY 2018-2019
1
RESOLUTION NO. 14684
RESOLUTION OF THE SAN RAFAEL CITY COUNCIL 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 2018-2019
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, 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 FY 2018-2019.
2. The City Manager is authorized to execute the required Intergovernmental Agreement
Regarding Transfer of Public Funds with the DHCS and the required Health Plan
Provider Agreement with PHC, 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
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
2
of actuarially-sound Medi-Cal managed care capitation rate increases for the
Partnership Health Care period of July 1, 2018 through June 30, 2019.
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 17th day of June 2019, by the following vote, to wit:
AYES: COUNCILMEMBERS: Bushey, Colin, McCullough & Mayor Phillips
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: Gamblin
LINDSAY LARA, City Clerk
CONTRACT #18-95612
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 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 July 1, 2018 through June 30, 2019 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
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CONTRACT #18-95612
money excluded from use as State match, impermissible taxes, and non -bona fide provider -
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 July 1, 2018 through June 30,
2019 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 June 30, 2019. If this 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 this 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 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
of Medi -Cal Managed Care actuarially sound capitation rates described in section 14301.4(b)(4)
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CONTRACT #18-95612
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 July 1, 2018 through June 30, 2019, 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
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.
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CONTRACT #18-95612
3.3 The 20 -percent assessment fee pursuant to this Agreement is non-
refundable and shall be wired to DHCS separately from, and simultaneous to, 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 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:
Jim Schutz, City Manager
City of San Rafael
1400 Fifth Avenue
San Rafael, CA 94901
Jim. S chutz 0mci tyo fs anrafael . org
With copies to:
Chris Gray, Fire Chief
San Rafael Fire Department
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CONTRACT #18-95612
To DHCS:
1600 Los Gamos Drive, Suite 345
San Rafael, CA 94903
Chris. Gray @cityofsanrafael.org
and
Jeff Ingram, Director, FP&A
Partnership HealthPlan of California
4665 Business Center Drive
Fairfield, CA 94534
jingram a partnershiphp.org
Sandra Dixon
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., Suite 71-4002
MS 4413
Sacramento, CA 95814
Sandra.Dixon(@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.
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CONTRACT #18-95612
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.
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 July 1, 2018 and shall expire as of
December 31, 2021 unless terminated earlier by mutual agreement of the parties.
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CONTRACT #18-95612
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on
the date of the last signature below.
THE CITY OF SAN RAFAEL FIRE DEPARTMENT:
By: Date:
Jim c utz, City Ma4er, City of San Rafael
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
Date:
Jennifer Lopez, Division Chief, Capitated Rates Development Division
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CONTRACT #18-95612
Exhibit 1
Funding Entity: f City of San Rafael Fire Department _
Health Plan: Partnership Health Plan
Rating Region: (Southern Region
Service Months: 17/2018 -12/2018
RateCategory
Contribution PMPM
Estimated Member
Months
Estimated
Contribution (Non-
NonRate
Federal Share)
Child - non MCHIP
$ 0.06
373,723
$ 22,423
Child - MCHIP
$ 0.01
180,284
$ 1,803
Adult - non MCHIP
$ 0.15
188,712
$ 28,307
Adult - MCI -UP
$ 0.04
4,776
$ 191
SPD
$ 0.46
99,161
$ 45,614
SPD/Full-Dual
$ 0.11
150,107
$ 16,512
BCCTP
$ 0.74
765
$ 566
LTC
$ 1.78
398
$ 708
LTC/Fuff Dual
$ 1.47
6,827
$ 10,036
OBRA
$ 0.10
1,781
$ 178
Whole Child Model
$ -
-
$ -
Optional Expansion
$ 0.02
392,835
$ 7,857
Estimated Total
1,399,369
$ 134,195
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CONTRACT #18-95612
Funding Entity: City of San Rafael Fire Department
Health Plan:Pa_rtiership Healt_h_Plan
R _
Rating _ Region: _ 'Southern Region
Service Months: 1/2019 - 6/2019
Rate Category
Contribution PMPM
Estimated Member
Months
Estimated
Contribution (Non -
Federal Share)
Child - non MCHIP
$ 0.05
367,642
$ 18,382
Child - MCHIP
$ 0.01
180,996
$ 1,810
Adult - non MCHIP
$ 0.16
183,887
$ 29,422
Adult - MCHIP
$ 0.04
4,693
$ 188
SPD
$ 0.46
98,072
$ 45,113
SPD/Full-Dual
$ 0.12
148,780
$ 17,854
BCCTP
$ 0.83
734
$ 609
LTC
$ 1.85
384
$ 710
LTC/Full-Dual
$ 1.49
6,593
$ 9,824
OBRA
$ 0.11
1,147
$ 126
Whole Child Model
$ 1.08
17,879
$ 19,309
Optional Expansion
$ 0.02
390,435
$ 7,809
Estimated Total
1,401,242
$ 151,156
Template Version- 712018
David Catalinotto
From: Dixon, Sandra (CRDD-CRDB-FMS)@DHCS <Sandra.Dixon@dhcs.ca.gov>
Sent: Tuesday, May 21, 2019 10:13 AM
To: Chris Gray; David Catalinotto
Cc: Achusim, Ruth (HCP-CRDD)
Subject: RE: Approval and Boilerplate: 2018-19 Rate Range Program
Attachments: 2018-19 IGT Agreement -San Rafael rl.dotx
Attached is the final 2018-19 Voluntary Rate Range Program agreement between DHCS and the governmental funding
entity. Please obtain the necessary signature(s) on five originally signed copies of the agreement, and send the signed
agreements to me for execution on or before July 31, 2019 at:
Sandra Dixon
Capitated Rated Development Division
California Department of Health Care Services
1501 Capitol Avenue, MS 4413
Sacramento, CA 95814
This Agreement is of no force and effect until signed by all parties. Do not submit any agreements/contracts between
the health plans and providers related to the 2018-19 Rate Range Program.
Your e-mail dated May 17, 2019 contained the 2017-18 Rate Range Program agreement instead of the 2018-19. The
2017-18 Notices and Signature information was incorporated into the 2018-19 draft agreement. If you have any
questions, please contact me via e-mail or at (916) 345-8269.
From: Dixon, Sandra (CRDD-CRDB-FMS)@DHCS
Sent: Monday, May 06, 2019 12:32 PM
To:'Chris.Gray@cityofsanrafael.org' <Chris.Gray@cityofsanrafael.org>
Cc: Achusim, Ruth (HCP-CRDD) <Ruth.Achusim@dhcs.ca.gov>
Subject: Approval and Boilerplate: 2018-19 Rate Range Program
Hello, City of San Rafael:
Welfare and Institutions Code, sections 14164 and 14301.4, authorize the Department of Health Care Services
(DHCS) to implement a voluntary Rate Range Program relating to the Medi -Cal managed care capitation rate
ranges. The funding amounts under the Rate Range Program are the nonfederal share of the difference
between the Medi -Cal managed care plans' contracted capitation rates and the top of the plans' actuarially
sound rate range, as determined by the DHCS. The funds voluntarily transferred by the governmental funding
entity (county, city, special purpose district, State University teaching hospital, State of California, or any other
political subdivision of the state) to DHCS for this program shall be used to fund the nonfederal share of Medi -
Cal managed care actuarially sound capitation rates described in section 14301.4(b)(4) of the Welfare and
Institutions Code. These funds shall be paid, together with the related federal financial participation, by DHCS
to Medi -Cal managed care plans as part of capitation rates for the period of July 1, 2018 through June 30,
2019.
DHCS received your letter(s) of interest (see attached) regarding the 2018-19 Rate Range
Program. Subsequent to our letters sent to plans in July 2018, DHCS adjusted the available rate range
funding calculation to reflect updated member month estimates and capitation rates; your updated estimated
contribution amount is $285,351. Please refer to the attached document titled "Intergovernmental Agreement
Regarding Transfer of Public Funds" for the actual contribution per member per month amounts by rate
category. In accordance with Welfare and Institutions Code section 14301.4(d) and 14301.5(b)(4), and
pursuant to the terms of the attached agreement, DHCS has determined that an estimated $0.00 of the total
contribution amount will not be subject to a 20% assessment fee.
Each governmental funding entity that has chosen to participate in the Rate Range Program must complete the
attached draft "Intergovernmental Agreement Regarding Transfer of Public Funds," between the governmental
funding entity and DHCS. Complete section 5 — Notices (individual's name, mailing address and e-mail
address), and in the Signature section, include the name of the governmental funding entity as well as the
name and title of the person executing the agreement. Do not, however, sign the agreement at this time. All
other sections have been completed by DHCS.
Upon completion, the agreement must be e-mailed to: Sandra. Dixon(cildhcs.ca.gov by May 17, 2019. The
agreement needs to be completed but not signed. After DHCS review, we will resend the final agreement to
you for signature.
Below is the anticipated timeline for this program:
Estimated Timeline for the 2018-19 Rate Range Program
Completed draft documents (notifications & signature
line) submitted by funding entity to DHCS
5/17/2019
Agreements sent back to funding entity for signatures
5/31/2019
Signed Agreements due to State from funding entity
7/31/2019
Wiring of Incoming Funds
Approx. 3rd/4th
quarter of SFY
2019-20
The anticipated timeline is subject to change, and you will notified via e-mail or letter regarding the actual due
dates. If you have any questions, please feel free to contact me by e-mail at Sandra. Dixon(cD_dhcs.ca.gov, or by
phone at (916) 345-8269.
Sandra Dixon
Department of Health Care Services
Capitated Rate Development Division
916-345-8269
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CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Fire
Project Manager: Christopher Gray Extension: 3084
Contractor Name: California Department of Health Care Services
Contractor's Contact: Sandra Dixon Contact's Email: Sandra.Dixon@dhcs.ca.gov
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
DATE
Check/Initial
1
Project Manager
a. Email PINS Introductory Notice to Contractor
N/A
❑
N/A
b. Email contract (in Word) and attachments to City
Attorney c/o Laraine.Gittens@cityofsanrafael.org
❑
2
City Attorney
a. Review, revise, and comment on draft agreement
N/A
and return to Project Manager
N/A
❑
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
❑
3
Department Director
Approval of final agreement form to send to
N/A
❑
contractor
4
Project Manager
Forward three (3) originals of final agreement to
N/A
❑
contractor for their signature
5
Project Manager
When necessary, contractor -signed agreement
❑ N/A
agendized for City Council approval *
*City Council approval required for Professional Services
❑
Agreements and purchases of goods and services that exceed
Or
$75,000; and for Public Works Contracts that exceed $175,000
6/17/2019
Date of City Council approval
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
6
Project Manager
Forward signed original agreements to City
Attorney with printed copy of this routing form
7
City Attorney
Review and approve hard copy of signed
?��
agreement
8
City Attorney
Review and approve insurance in PINS, and bonds
��
(for Public Works Contracts)
%%�1 9
9
City Manager/ Mayor
Agreement executed by City Council authorized
—7 ---I(,
official
I
10
City Clerk
Attest signatures, retains original agreement and
forwards copies to Project Manager
June 11, 2019
Dear Providers:
On May 15, 2019, Partnership HealthPlan of California’s (PHCs) Finance Committee authorized
PHC to increase the reasonable and moderate administrative fee from 3% to an up to amount of
10% to all intergovernmental transfers (IGTs) beginning in fiscal year (FY) 2019-2020 and
beyond.
PHC has been administering IGTs since FY 2009-2010, allocating a significant amount of staff
time and resources to administer IGTs with interested counties, fire districts, and district hospitals
and have only recently began applying an administrative fee, even though many, if not all, of the
other health plans administering IGTs have charged up to 30% to administer the program.
This program has allowed Medi-Cal managed care plans, counties, fire districts, and certain types
of public hospitals with taxing authority to work with the State of California in order to bring
federal Medicaid matching dollars to the local level. This program has also been a valuable way
for PHC to support its provider network, increase access to health care services for members, and
improve members’ health status. The increase to the administrative fee will be used to further
PHCs support.
Sincerely,
Elizabeth Gibboney
Chief Executive Officer
Partnership HealthPlan of California
HEALTH PLAN -PROVIDER AGREEMENT
Partnership HealthPlan of California and City of San Rafael
Fire Department
This Amendment is made this day of , by and between Partnership HealthPlan 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 1, 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 PLAN covered health care services to PLAN beneficiaries 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, 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 Fire Department to the California Department of
Health Care Services ("State DHCS") to maintain the availability of PLAN covered health care
services to PLAN beneficiaries.
NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows:
Attachment E to the Agreement is hereby deleted in its entirety and replaced with a new
Attachment E as set forth herein and is incorporated into the Agreement.
City of San Rafael f=ire DepartmentTartnership Healthplan
IGT MEDI-CAL MANAGED CARE CAPITATION INCREASES
1. IGT Capitation Increases to PLAN
A. Payment
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 City of San Rafael Fire Department effective July 1, 2019 for Intergovernmental
Transfer Medi -Cal Managed Care Increases ("IGT MMCIs"), PLAN shall pay to PROVIDER
the amount of the IGT MMCIs received from State DHCS, in accordance with paragraph LE
below regarding the form and timing of Local Medi -Cal Managed Care ("LMMC") IGT
Payments. LMMC 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
The PLAN shall be responsible to pay the applicable State Agency
pursuant to the Revenue and Taxation Code Section 6175 relating to any IGT MMCIs.
(2) The PLAN shall retain up to ten percent (10%) administrative fee based on
the total amount of the IGT MMCIs received from DHCS for PLAN'S administrative costs.
Each provider's share of the 10% fee shall be calculated based on that provider's proportionate
share of the LMMCIGT payments made by Plan in the PROVIDER'S County.
C. Form and Timing of Payments
PLAN agrees to pay LMMC IGT Payments to PROVIDER in the following form
and according to the following schedule:
(1) PLAN agrees to pay the LMMC IGT 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 LMMCIGT Payments to PROVIDER no later than
thirty (30) calendar days after receipt of the IGT MMCIs from State DHCS.
D. Consideration
(1) As consideration for the LMMC IGT Payments, PROVIDER shall use the
LMMC IGT Payments for the following purposes and shall treat the LMMC IGT Payments in
the following manner:
(a) The LMMC IGT Payments shall represent compensation for Medi -
Cal PLAN services rendered to Medi -Cal PLAN members by PROVIDER during the State fiscal
year to which the LMMC IGT Payments apply.
2
City of San Rafael Fire DepartmenWartnership Healthplan
(2) If the retained LMMC IGT Payments, if any, are not used by PROVIDER
in the State fiscal year received, retention of funds by PROVIDER will be established by
demonstrating that the retained earnings account of PROVIDER at the end of any State fiscal
year in which it received payments based on LMMC 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 of LMMC IGT Payments received, but not used.
(3) Both parties agree that none of these funds, either from the
GOVERNMENTAL FUNDING ENTITY City of San Rafael Fire Department or federal
matching funds will be recycled back to the GOVERNMENTAL FUNDING ENTITY City of
San Rafael Fire Department 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.
E. Cooperation Among Parties
Should disputes or disagreements arise regarding the ultimate computation or
appropriateness of any aspect of the LMMC IGT Payments, PROVIDER and PLAN agree to
work together in all respects to support and preserve the LMMC IGT Payments to the full extent
possible on behalf of the safety net in Marin County.
F. Reconciliation
Within one hundred twenty (120) calendar days after the end of each of PLAN's
fiscal years in which LMMC IGT Payments were made to PROVIDER, PLAN shall perform a
reconciliation of the LMMC IGT Payments transmitted to the PROVIDER during the preceding
fiscal year to ensure that the supporting amount of IGT MMCIs were received by PLAN from
State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCIGT Payments
made in error to PROVIDER within thirty (30) calendar days after receipt from PLAN of a
written notice of the overpayment error, unless PROVIDER submits a written objection to
PLAN. Any such objection shall be resolved in accordance with the dispute resolution processes
set forth in Section 10.3 of the Agreement. The reconciliation processes established under this
paragraph are distinct from the indemnification provisions set forth in Section J below. PLAN
agrees to transmit to the PROVIDER any underpayment of LMMC IGT Payments within thirty
(30) calendar days of PLAN's identification of such underpayment.
G. 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 LMMC IGT arising from the Intergovernmental Agreement. Recovery
by PLAN pursuant to this section shall include, but not be limited to, reduction in future LMMC
IGTs paid to PROVIDER in an amount equal to the amount of MMCI payments withheld or
recovered from PLAN, or by an offset of any other amounts owed by PLAN to PROVIDER,
including but not limited to payments for direct service rendered.
3
City of San Rafael Fire Department\Partnership Healthplan
Remittance Information
The IGT -funded payments made by the PLAN pursuant to this Amendment only, shall be mailed
to the PROVIDER at the address set forth below:
Jim Schutz, City Manager
City of San Rafael Fire Department
1400 Fifth Ave
San Rafael, CA 94901
2. Term
The term of this Amendment shall commence on July 1, 2019 through June 30, 2024. PHC
reserves the right to immediately terminate this IGT Amendment prior to June 30, 2024, if
DHCS suspends or discontinues the IGT funding described in this Amendment. PHC will
promptly provide formal notice to the provider upon said suspension or discontinuation.
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, if there is any conflict between the terms of this Amendment and the
Agreement, then the terms of this Amendment shall govern.
SIGNATURES
HEALTH PLAN:
Date:
By: Elizabeth Gibboney, CEO, Partnership HealthPlan of California
>"ROVIDER: 2 Date: '1
By: Jim Schutz, anager, Ci o an Rafael Fire Department
4
City of San Rafael Fire Department\Partnership Healthplan
David Catalinotto
From: Belinda Love <blove@partnershiphp.org>
Sent: Monday, June 24, 2019 11:55 AM
To: David Catalinotto
Subject: RE: 2019 IGT Agreement _City of San Rafael Fire Department (Marin County)
Attachments: city of san rafael fire dept. IGT Plan -Provider Amendment.pdf
David,
PHC is reissuing this IGT amendment due to a correction needed for page 4. On page 4, Section (G) (2) Term, 1s*
sentence; is updated to correct the end date which should be through June 30, 2024.
Please disregard the previous amendment. Sign this amendment, return to my attention via email, or mail.
Thank you
Belinda Love
Contract Specialist II
Provider Relations
Partnership HealthPlan of California
4665 Business Center Drive, Faifeld CA 94534
Phone: (707) 420-7635 1 Fax: (707) 863-4317
Email: blove@partnershiphp.org
Normal work hours: 7am-4:30pm. Monday - Friday (Note: I am off every other Friday)
Our website: www.partnershiphp.org
PHC Mission: To help our members, and the communities we serve, be healthy
From: Belinda Love
Sent: Tuesday, June 11, 2019 1:01 PM
To: 'David Catalinotto' <David.Catalinotto@cityofsanrafael.org>
Subject: 2019 IGT Agreement_City of San Rafael Fire Department (Marin County)
David,
Attached is the July 2019 IGT Amendment between Partnership Healthplan of California (PHC), and City of San
Rafael Fire Department.
Please executed and return to my attention via email, or mailing address noted directly below.
Thank you
Belinda Love
Contract Specialist II
Provider Relations
Partnership HealthPlan of California
4665 Business Center Drive, Fairfield CA 94534
RAP
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Cary WITH P�\�
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: Christopher Gray Extension: 3084
Contractor Name: Partnership HealthPlan of California
Contractor's Contact: Belinda Love Contact's Email: Blove@partnershiphp.org
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
DATE
Check/Initial
1
Project Manager
a. Email PINS Introductory Notice to Contractor
N/A
❑
N/A
b. Email contract (in Word) and attachments to City
Attorney c/o Laraine.Gittens@cityofsanrafael.org
❑
2
City Attorney
a. Review, revise, and comment on draft agreement
N/A
and return to Project Manager
N/A
❑
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
❑
3
Department Director
Approval of final agreement form to send to
N/A
❑
contractor
4
Project Manager
Forward three (3) originals of final agreement to
N/A
❑
contractor for their signature
5
Project Manager
When necessary, contractor -signed agreement
❑ N/A
agendized for City Council approval *
*City Council approval required for Professional Services
❑
Agreements and purchases of goods and services that exceed
Or
$75,000; and for Public Works Contracts that exceed $175,000
6/17/2019
Date of City Council approval
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
6
Project Manager
Forward signed original agreements to City
Attorney with printed copy of this routing form
7
City Attorney
Review and approve hard copy of signed
agreement
8
City Attorney
Review and approve insurance in PINS, and bonds
/.U 4)
(for Public Works Contracts)
(J
9
City Manager/ Mayor
Agreement executed by City Council authorized
G
L
official
10
City Clerk
Attest signatures, retains original agreement and
forwards copies to Project Manager
Funding Entity:
Health Plan:
Rating Region:
Service Months: 7/2018 - 12/2018
Rate Category Contribution PMPM
Estimated Member
Months
Estimated
Contribution (Non-
Federal Share)
Child - non MCHIP 0.06$ 373,723 22,423$
Child - MCHIP 0.01$ 180,284 1,803$
Adult - non MCHIP 0.15$ 188,712 28,307$
Adult - MCHIP 0.04$ 4,776 191$
SPD 0.46$ 99,161 45,614$
SPD/Full-Dual 0.11$ 150,107 16,512$
BCCTP 0.74$ 765 566$
LTC 1.78$ 398 708$
LTC/Full-Dual 1.47$ 6,827 10,036$
OBRA 0.10$ 1,781 178$
Whole Child Model -$ - -$
Optional Expansion 0.02$ 392,835 7,857$
Estimated Total 1,399,369 134,195$
City of San Rafael Fire Department
Partnership Health Plan
Southern Region
Funding Entity:
Health Plan:
Rating Region:
Service Months: 1/2019 - 6/2019
Rate Category Contribution PMPM
Estimated Member
Months
Estimated
Contribution (Non-
Federal Share)
Child - non MCHIP 0.05$ 367,642 18,382$
Child - MCHIP 0.01$ 180,996 1,810$
Adult - non MCHIP 0.16$ 183,887 29,422$
Adult - MCHIP 0.04$ 4,693 188$
SPD 0.46$ 98,072 45,113$
SPD/Full-Dual 0.12$ 148,780 17,854$
BCCTP 0.83$ 734 609$
LTC 1.85$ 384 710$
LTC/Full-Dual 1.49$ 6,593 9,824$
OBRA 0.11$ 1,147 126$
Whole Child Model 1.08$ 17,879 19,309$
Optional Expansion 0.02$ 390,435 7,809$
Estimated Total 1,401,242 151,156$
City of San Rafael Fire Department
Partnership Health Plan
Southern Region