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HomeMy WebLinkAboutResolution 2014-025 N.C.S. 2/24/2014 Resolution No. 2014-025 N.C.S. of the City of Petaluma, California AUTHORIZING THE CITY MANAGER TO SIGN AN AGREEMENT WITH THE SACRAMENTO METROPOLITAN FIRE DISTRICT FOR RECOVERY OF ADMINISTRATIVE COSTS FOR IMPLEMENTATION AND RECOVERY OF SUPPLEMENTAL GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) PAYMENTS WHEREAS, Federal and State insurance programs such as Medi-Care and Medicaid/Medi-Cal, reimburse Ground Emergency Medical Transportation (GEMT) service providers for the cost of providing services to insureds at mandated rates, resulting in unreimbursed costs of service incurred by GEMT service providers such as the City of Petaluma Fire Department; and, WHEREAS, although the City incurs substantial costs for unreimbursed GEMT services (i.e., equal to approximately 46.22% of GEMT service billings for 2013), it can only contractually bill and expect payment for a certain amount; and, WHEREAS, California Welfare and Institutions Code section 14105.94, enacted October 2, 2011, authorized the GEMT Services Supplemental Reimbursement Program (the "Program") which provides additional reimbursement to eligible public agency GEMT service providers to help reduce the unreimbursed costs of GEMT service providers; and, WHEREAS, asa.Medi-Cal-enrolled, public agency GEMT service provider, the City of Petaluma is eligible to participate in the Program; and, WHEREAS, by participating in the Program, the City may receive additional reimbursement for GEMT services thereby reducing the City's unreimbursed GEMT service costs for the period January 30, 2010 through December 31, 2013 by an estimated $50,466.68; and, WHEREAS, the State has entered into an agreement with the Sacramento Metropolitan Fire District to administer the Program, including providing reimbursements to eligible Resolution No. 2014-025 N.C.S. Page 1 participant GEMT agencies and recovering from such agencies costs of administering the Program incurred by the State and Sacramento Metropolitan Fire District; and, WHEREAS, in order to participate in the Program, eligible GEMT agencies must enter into an agreement with the Sacramento Metropolitan Fire District providing for payment of supplemental GEMT service cost reimbursement and recovery of program administration costs of the Sacramento Metropolitan Fire District and the State. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Petaluma, as follows: 1 . The proposed agreement with Sacramento Metropolitan Fire District for recovery of administrative costs for implementation and recovery of ground emergency medical transportation payments which is attached to this resolution as Exhibit A is hereby approved, and the City Manager is authorized to sign the agreement on behalf of the City. Under the power and authority conferred upon this Council by the Charter of said City. REFERENCE: 1 hereby certify the foregoing Resolution was introduced and adopted by the Approved . to Council of the City of Petaluma at a Regular meeting on the 24th day of February, orm: 2014,by the following vote: City AttorneY AYES: Albertson. Barrett, Mayor Glass. Barris. Healy,Vice Mayor Kearney, Miller NOES: None ABSENT: None ABSTAIN: None l 40P 7, ATTEST: @.�` /"tel ) ( ALX _ c City Clerk Mayor Resolution No.2014-025 N.C.S. Page 2 Exhibit A to Resolution AGREEMENT FOR RECOVERY OF ADMINISTRATIVE COSTS FOR IMPLEMENTATION AND RECOVERY OF GROUND EMERGENCY MEDICAL TRANSPORTATION PAYMENTS This agreement is made and entered into on this_day of 201_ between the Sacramento Metropolitan Fire District, ("Metro Fire')a political subdivision of the State of California.and, , ("GEMT Transporter"). WHEREAS,the State Department of Health Care Services ("State") has developed and is administering the Medi-Cal Ground Emergency Transportation Supplemental Reimbursement Program pursuant to the California Welfare and Institutions Code Section 14105.94:and State Plan Amendments 09-024;and, WHEREAS, the State has entered into an agreement with Metro Fire for administrative services related to the Medi-Cal Ground Emergency Transportation Supplemental Reimbursement Program pursuant to Welfare and Institutions Code Section 14105.94 and State Plan Amendments 09-024,which agreement is attached hereto as Exhibit A, and is incorporated as if set forth fully herein; and, WHEREAS under Welfare and Institutions Code Section 14105.94 an eligible provider of ground emergency medical transportation servicesmay be entitled to supplemental Medi-Cal reimbursementas set forth in those provisions; and, WHEREAS an eligible provider as described in the afore mentioned section is required to enter intoan agreementto reimburse the State for implementing and administering the Supplemental Reimbursement Program as a condition of receiving supplemental reimbursement pursuant to that section;and, WHEREAS Metro Fire has been designated, by the contract attached as Exhibit A, to recover the•administrative and implementation costs required to be paid by eligible providers under that section; and, WHEREAS Metro Fire will incur administrative and other costs in connection with billing GEMT Transporter for costs, and has assumed the risk of payment, or non- payment of the costs from GEMT Transporter; NOW therefore, the Parties enter into this.contract for the purpose of setting forth the agreement for payment of administrative costs by the eligible GEMT providers to Metro Fire, under the following terms and conditions. 1. PARTIES Metro Fire.is.a designated agency for the collection of costs related to the GEMT Supplemental Medi-Cal Reimbursement Program. GEMT Transporter is.an eligible provider of GEMT services as described in Welfare and Institutions Code'Section 14105.94. Page 1 of 6 Resolution No. 2014-025 N.C.S. Page 3 II. TERMS This agreement shall be effective and commence as of July 1, 2011 and shall end on June 30, 2014. However, GEMT transporter acknowledges,and agrees that cost reports submitted by GEMT Transporters are subject to audit by the State of California for a period of thirty six (36) months from the date of submission of the reports by the GEMT Transporter to the State of California. During that period of time, State administrative costs as defined in Welfare and Institutions Code 14105.94 will continue to be incurred:by the State for which the GEMT Transporter agrees to pay to Metro Fire pursuant to paragraph IV below. The GEMT Transporter agrees to pay its transporter share of administrative costs pursuant to paragraph V after the termination of this agreement, whether this agreement is terminated by its term, or in the event GEMT ' Transporter elects to terminate the agreement, or in the event that Metro Fire terminates the agreement. III. RATIFICATION Where there has been a need for Metro Fire to provide services essential to the initial start-up of the GEMT program in the State of California and where such services have been provided prior to the date of execution of this agreement, both Parties agree that the-calculation, and payment, of services under this Agreement shall begin on July 1, 2011_ IV. SCOPE OF SERVICES AND RESPONSIBILITIES Metro Fire will provide the following services: A. Advance of GEMT administration costs to the State as provided by SPA 09-024 on behalf of the GEMT Transporter. B. Assistance to the State GEMT program on behalf of the GEMT Transporters including: a. Cost Report development b. Information resource to the State and Federal governments c. Program development.to expand the scope of eligible costs C. Assistance to the GEMT Transporter including: a. Program guidance via telephone b. Ombudsman services when needed c. Advocate for reimbursements d. Government relations The GEMT Transporter will provide the following services: A. Accurate reports of transports eligible under the GEMT program B. Accurate record keeping and retention of records for a period of not less than 7 years C. Provide all records upon request for audit purposes Page 2 of 6 Resolution No. 2014-025 N.C.S. Page 4 V. PAYMENT TERMS GEMT Transporter agrees to pay Metro Fire the transporters share of the State administrative costs as defined in Welfare and Institutions Code Section 14105.94. The GEMT transporter share will be based upon the administrative costs per fee for service Medi-Cal transport, multiplied by the GEMT Transporter's number of fee.for service Medi-Cal transports for each reporting period. The administrative costs per fee for service Medi-Cal transport will be determined by the State of California based on the total administrative costs of the State in administering the GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES SUPPLEMENTAL REIMBURSEMENT PROGRAM divided by the_total number of fee for service Medi-Cal transports statewide by all participating transporter agencies for each reporting period. In addition,the GEMT transporter will compensate Metro Fire one percent (1%)of the GEMT transporter's gross State Supplemental Reimbursement ofGEMT services under Welfare and Institutions Code Section 14105.94 for each reporting period for Metro Fire's program services, administrative services,expansion of program for future reimbursements, contracting services, other expenses,cost of advancing funds for the State, and the risk of non-payment. A. Metro Fire will notify, via email, the amount due under V of this agreement by the GEMT Transporter once the amount is determined. B. All amounts due under this agreement will be paid via an ACH electronic debit transaction initiated by Metro Fire no sooner-than 30 days after the first notification is sent to the GEMT Transporter. C. The GEMT Transporter will complete the attached Direct Payment Authorization Form authorizing Metro Fireto initiate the debit payment of the amounts due to Metro Fire pursuant to this agreement. 1. It is the responsibility of the GEMT Transporter to keep the Direct Payment Authorization Form up to date with the most current financial institution information. D. Non-payment by the GEMT Transporter due to insufficient funds or other reasons will result in a termination of the agreement pursuant to Provision XII. 1. The breach to this agreement may be cured by: 1) having the amount due plus any additional bank fees incurred by Metro Fire (if any) availablein the 'financial institution named on the Direct Payment Authorization Form and 2)the successful completion of the debit transaction including additional banking fees. 2. The State will not provide GEMT supplemental reimbursements to the GEMT Transporter without a valid Agreement for Recovery of Administrative Costs for Implementation and Recovery of GEMT Payments with Metro Fire. Page 3 of 6 Resolution No. 2014-025 N.C.S. Page 5 VI. REIMBURSEMENT COSTS ACKNOWLEDGMENT The GEMT Transporter acknowledges and agreesthat the compensation paid to Metro Fire pursuant to this agreement is intended to cover the costs for administering the supplemental reimbursement program under Welfare and Institutions Code Section 14105.94 for its costs under Welfare and Institutions Code Section 14105.94(d). The compensation payable to Metro Fire is approved by the State, pursuant to the contract between the State and Metro Fire as set forth in the contract attached as Exhibit A. The GEMT Transporter hereby agrees to waive any claim,action, or challenge to the payment method for the collection of costs under Welfare and Institutions Code Section 14105.94(d), in the mannerset forth in this agreement. VII. DISPUTE RESOLUTION In the event of a dispute between the Parties in the terms of this agreement as to any issue arising under this Agreement, the Parties agree to meet and negotiate in good faith to resolve such dispute. This shall not limit the Parties' right to pursue any available remedies at law or in equity. VIII. MUTUAL INDEMNIFICATION It is agreed that the GEMT Transporter shall defend, hold harmless and indemnify Metro Fire, its officers, employees, and agents from any and all claims liability, loss or expense (including reasonable attorney fees) for injuries or damage to any person and/or any property which arise out of the terms and conditions of this Agreement and the negligent or intentional acts or omissions of the GEMT Transporter and its officers, employees or agents. It is further agreed that Metro Fire shall defend, hold harmless and indemnify the GEMT Transporter and its officers, employees, and agents from any and all claims liability, loss or expense (including reasonable attorney fees) for injuries or damage to any person and/or any property which arise out of the terms and conditions of this Agreement and the negligent or intentional acts or omissions of Metro Fire, its officers, employees, or agents. IX. SEVERABILITY If any term, condition, or provision of this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions will nevertheless continue in full force and effect, and shall not be affected, impaired or invalidated in any way. Notwithstanding the previous sentence, if a decision by a court of competent jurisdiction invalidates, voids, or renders unenforceable a term, condition, or provision in this Agreement that is included in the purpose of this Agreement then the Parties to this Agreement shall either amend this Agreement pursuant to Provision X. Or it shall be terminated. Page 4 of 6 Resolution No. 2014-025 N.C.S. Page 6 X. AMENDMENT AND WAIVER Except as provided herein, no alteration,amendment, variation,or waiver of the terms of this Agreement shall be valid unless made in writing and signed by both Parties. Waiver by either party of any default, breach or condition precedent shall not beconstrued as a waiver of any other default, breach or condition precedent, or any other right hereunder. XI. INTERPRETATION This Agreement shall be deemed to have been prepared equally by both of the Parties, and the Agreement and its individual provisions shall not be construed or interpreted more favorably for one party on the basis that the other party prepared it. XII. TERMINATION Either of the Parties may terminate this Agreement upon thirty (30)days written notice to the other party. Notice shall be deemed served on the date of mailing. GEMT Transporter's responsibility for administrative costs incurred by-the State associated with transporter costs reports and/or the State's audit of those'costs shall survive the termination of the agreement. XIII. PRIOR AGREEMENTS This Agreement constitutes the entire contract between Metro Fire and GEMT Transporter regarding the subject matter of this Agreement. Any prior agreements, whether oral or written, between Metro Fire and GEMT Transporter regarding the subject matter of this Agreement are hereby terminated effective immediately upon full execution of this Agreement. XIV. INTEGRATION CLAUSE This Agreement and any exhibits attached hereto shall constitute the entire agreement among the Parties to it and supersedes any prior or contemporaneous understanding or agreement with respect to the services contemplated, and may be amended only by a written amendment executed by both Parties to this Agreement. XV. CONTROLLING LAW The validity of this Agreement and its terms or provisions, as well as the rights and duties of the Parties hereunder,the interpretation and performance of this Agreement shall be governed by the laws of the State of California. Page 5 of 6 Resolution No. 2014-025 N.C.S. Page 7 SACRAMENTO METROPOLITAN FIRE DISTRICT Signature: Name: Scott Clough Title: Assistant Chief Date: GEMT Transporter Signature: Name: Title: Date: Page 6of 6 Resolution No. 2014-025 N.C.S. Page 8 SIGNATURE ROUTING SHEET FOR AGREEMENT FOR RECOVERY OF ADMINISTRATIVE COSTS FOR IMPLEMENTATION AND RECOVERY OF GROUND EMERGENCY MEDICAL TRANSPORTATION PAYMENTS (Agreeinent/Project Title) Please keep the original of this document with the City Clerk's executed original of the contract. CITY OF PETALUMA City Manager ATTEST: City Clerk APPROVED AS TO FORM: City Attorney APPROVED: Department Director APPROVED: Risk Manager APPROVED: Finance Director nnne.C;; i I Rcmmuremmi S]cinu¢3�miep SL.n �.S-lrcb 20] Resolution No.2014-025 N.C.S. Page 9