HomeMy WebLinkAboutStaff Report 3.H 06/01/2015Agenda Item #3.H
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DATE: June 1, 2015
TO: Honorable Mayor and Members of the City Council t, ough the City Manager
FROM: Leonard C. Thompson, Interim Fire Chief
Dave Kahn, Battalion Chief -Fire Admin
SUBJECT: Resolution Authorizing the City Manager to Execute an Agreement for
Intergovernmental Transfer with Partnership HealthPlan of California
RECOMMENDATION
It is recommended that the City Council adopt the attached Resolution Authorizing the City
Manager to Execute an Agreement for Intergovernmental Transfer with Partnership HealthPlan
of California.
BACKGROUND
Since 2006, the California Department of Health Care Services (DHCS) has offered local
governments that provide health care the opportunity to secure additional Medi -Cal revenues by
participating in a voluntary Intergovernmental Transfer (IGT) program with their local Medi -Cal
managed care plan. Partnership HealthPlan of California (PHC) is a non - profit community-
based healthcare organization that contracts with the State to administer Medi -Cal benefits
through local care providers to ensure Medi -Cal recipients have access to high - quality
comprehensive cost - effective health care. Petaluma Fire is already in contract with PHC since it
bills and receives payments for PHC's covered Medi -Cal patients who are treated and
transported by Petaluma Fire ambulances. IGTs offer a way for Petaluma Fire to receive
additional Medi -Cal funds for ambulance services provided to PHC beneficiaries from FY 13/14
and moving forward. PHC collects data on each provider's costs, charges and revenues for Plan
services and recommends to DHCS which entities should be allowed to participate and at what
dollar amount. DHCS reviews PHC's recommendations and approves a specific dollar amount
for each entity. Local governments volunteer to participate in these IGTS; no entity is required
to participate. Currently, the following local entities that do participate include: Novato Fire
District, San Rafael Fire, Southern Marin Fire, Sonoma Valley Fire Rescue Authority, Bodega
Bay Fire and Cloverdale Fire.
The IGT process will result in PHC paying public ambulance providers additional Medi -Cal
revenues to offset previously unreimbursed costs for serving Medi -Cal plan members. The
payment amounts will be determined by: (1) the provider's unreimbursed costs (and /or charges);
(2) the number of other local governments participating in the IGTs in that county or region; (3)
PHC's recommendations; and (4)DHCS's formulas.
DISCUSSION
In a rate range IGT, the local government entity transfers funds to the State (the
"intergovernmental transfer ") which are used to increase the actuarially sound rates the State
pays the health plan and to reimburse the State for its administrative costs. The Plan then pays
the local provider the IGT - funded proceeds that the local government transfer made possible.
Because the local transfer is matched with Federal funds, the participating government provider
receives the amount of the transfer plus new funds as well. For every dollar transferred, the
provider receives a one -time Plan payment of approximately $1.60.
These rate range IGTs have been approved by the Federal government and are referenced in
California state law. They are similar to other types of IGTs and cost - sharing arrangements that
California uses to finance Medi -Cal payments to local governments providing services to Medi -
Cal patients.
The rate range IGT is implemented through three contracts: two with DHCS (attached to the
Resolution as Exhibits A and B) and one with PHC. These documents spell out the obligations
of each entity with regard to the transfer of local government funds, the use of the funds by
DHCS, the payment of funds to the provider and the treatment of the payments by the provider.
Before any funds are transferred, all contracts are signed by the participants and IGTs. Any Plan
rate increases are approved by the Federal government.
Participation in IGTs represents an opportunity for local government providers of Medi -Cal
services to re -coup a share of their costs for serving PHC patients. Using the IGT mechanism,
PHC will be able to pay the providers a lump sum Medi -Cal payment to cover costs that were
previously subsidized by the local government entity.
This approach is similar to the GEMT reimbursement program that Petaluma Fire joined last
year (via Resolution No. 14 -025 N.C.S.), with a few minor differences. The first difference is
that GEMT is for medical fee for service Medi -Cal patients or Medi -Cal patients not managed by
an HMO; reimbursement funds are received directly from the Federal government. The IGT
program is for Medi -Cal patients who have Medi -Cal coverage that is managed specifically
through Partnership HealthPlan HMO — equal to approximately 80% of HMO - managed Medi -
Cal patients. The second difference is that this is a matching program requiring money up front
to demonstrate what has been "spent" on Medi -Cal patients; the GEMT money is a
reimbursement program that provides money for uncovered service expenses already incurred.
Both programs are based on what the Federal and State government agencies determine to be an
actuarially sound rate for Medi -Cal patient costs. Since this is a match and not a reimbursement,
it is handled through Intergovernmental Transfers (IGTs).
A Medi -Cal IGT is a transfer of matchable funds from a unit of local government (whether it be
a County, District or City, etc.) to the State for use in funding the Medi -Cal program. The
Federal government pays half of the State's allowable Medi -Cal spending and requires all
managed care Plans to be paid at an actuarially sound rate. California tends to pay Plans at the
lower end of the actuarially sound rate range, leaving potential Federal matches unclaimed. In a
Rate Range IGT, the State uses transferred funds from local governments to increase the monthly
capitation rates it paid Medi -Cal managed care Plans in the prior fiscal year. As long as the rate
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increase does not exceed the upper range of what is actuarially sound, the Federal government
will match the transferred funds and pay half the Plan's rate increases. The Medi -Cal Managed
Care Plan pays most of its IGT- funded rate increases to the local government provider that
transferred the funds; the local entity receives its own funding, plus the federal match.
DHCS starts the process by directing PHC to submit its proposal for which entities will
participate in the IGTs and at what amounts. DHCS controls the timing of each step in the
process. PHC staff and its consultant (who provided the following detailed language) will assist
the local government entities in the IGT process, as outlined below in chronological order:
1. Cost and Service Data Collection: PHC will collect and submit data to DHCS on each
entity participating in the IGT. The data includes the cost of Medi -Cal services provided to
Plan members, the provider's billings to PHC, PHC revenues to the provider and the volume
of services provided. The data pertains to Fiscal Year 2013/14, which is the year to which the
State rate increased for PHC.
2. Letter of Interest: Each participating entity will submit a non - binding letter to PHC using a
DHCS provided template, to express interest in participating in the IGTs. Petaluma Fire has
completed this task.
3. Submission of PHC Proposal: PHC will submit an IGT proposal to DHCS approximately
three weeks after DHCS officially begins the process. The proposal will include the Plan's
recommendations regarding which entities will participate in the IGTs and how much they
will contribute to DHCS. Along with the proposal, PHC will submit the providers' data and
their signed letters of interest.
4. DHCS Approval of IGT Amounts: DHCS will review PHC's proposal and the data for
each participant and will decide if the recommended local contribution amount is reasonable
and considered appropriate payments to the providers. If DHCS agrees with PHC's proposed
amounts, they will send IGT document templates to each local government interested in
participating in the IGT (see Ex. A). DHCS also requires each entity participating in the IGT
to pay a 20% administrative fee to cover state administrative costs and to support the Medi-
cal program (see Ex. B).
5. Final Approval of Documents: DHCS will review and approve the completed draft
documents and ensure they conform to the Federal and State templates. Petaluma Fire has
completed this task. DHCS will ask the public entities to sign and submit the documents, at
which point they become legally binding contracts (hence the timing of this agenda item and
Resolution).
6. DHCS/PHC Rate Increase Contract: Based on the signed contracts to transfer local funds
to DHCS, the State will amend its contracts with PHC to increase per member, per month
capitation rates for Fiscal Year 2013/14 (the term of the PHC's most recent contracts with
DHCS). If there are sufficient public entity contributions, DHCS will increase PHC's rates
to the top of the rate range, the highest actuarially sound rate that qualifies for Federal
matching funds.
7. Wiring of Funds to DHCS: Once the Federal Centers for Medicare and Medicaid Services
(CMS) has approved the entire IGT transaction, and the PHC rate amendments have been
signed, DHCS will send each local government entity fully signed original copies of their
IGT contracts and will request that the local government wire its funds to the State within
seven days.
8. State Payment to the Plan: Six to eight weeks after receiving the wired funds, DHCS will
pay PHC its rate increase amounts in a lump sum deposited at the same time that it pays the
Plan its usual monthly capitation payments (the first week of the month).
9. Payment to the Provider: Upon receipt of the IGT - funded rate increases, PHC will pay
required State taxes of approximately 4 %, retain an additional 3% as the Plan administrative
fee and pay out the remainder of the fee increase pursuant to the Plan Provider Agreement
that it previously entered into with the local government. PHC has a maximum of thirty days
from receipt of the rate increase to pay the providers. As a result of the IGT, the provider
will receive a lump sum Medi -Cal payment from PHC that will cover some or all of its
unreimbursed cost for services previously provided to Plan members.
10. Rate of Return: For example, if the provider had $50,000 of unreimbursed costs for EMS
services to Plan members, DHCS would approve a maximum contribution from the local
government entity of approximately $81,000 (inclusive of the DHCS fee). The Plan payment
to the provider would be around $135,000, of which $50,000 would be net new funds.
11. Use of Funds: The total amount of PHC's payment to the provider is considered Medi -Cal
revenue. Pursuant to the terms of the Plan Provider Agreement, any revenue in excess of the
provider's uncompensated cost of care for Plan members must be used for health care
services. The definition of health care services is broad and the services can be provided to
the general population; they do not need to be Medi -Cal services provided exclusively to
Medi -Cal patients. Funds do not have to be expended in the year received and there is no
maintenance of effort requirement. Revenues in excess of costs may be used to operate
existing EMS services or to support new or improved health care programs and services.
The proposed IGT will allow public ambulance service providers, such as Petaluma Fire
Ambulance, to receive additional Medi -Cal payments to more fully compensate it for providing
EMS transport services to PHC members during the previous fiscal year. As a result of receiving
these additional revenues, Petaluma Fire will have the resources to support emergency medical
services or other health care programs, as approved by the City and /or City Council. These new
funds will benefit Medi -Cal plan enrollees, other underserved populations and residents in
general.
FINANCIAL IMPACTS
PHC has determined that the City of Petaluma needs to transfer funds equal to $104,921 from the
General Fund to DHCS, pursuant to sections 14164 and 14301.4 of the Welfare and Institutions
Code. In turn, the City will receive net new funds totaling $82,576 in the form of a lump sum
payment amount of $187,497 in supplemental Medi -Cal revenues. These figures were derived
from research completed by PHC based on documentation provided by Petaluma Fire. The
original funds provided by the City can be general tax revenues, patient fees or agency reserves
made up of a combination of sources, and in this case will come from fund balance on hand in
the City treasury. PHC's payment to each EMS provider will occur six to eight weeks after the
wiring of the originating funds, and an amount equal to the originating payment, plus any interest
that would have been earned on it during the period, will be returned to fund balance. Net funds
in excess of the originating payment will be budgeted for Fire Department use. Medi -Cal is a
major source of payment for locally provided ambulance services; receiving reimbursement for
the true cost of that care will be beneficial for local government providers of ambulance services.
ATTACHMENTS
1. Resolution
a. Exhibit A to the Resolution: Intergovernmental Agreement Regarding Transfer of Public
Funds
b. Exhibit B to the Resolution: Intergovernmental Transfer Assessment Fee
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ATTACHMENT 1
RESOLUTION AUTHORIZING THE
CITY MANAGER TO EXECUTE AN AGREEMENT
FOR INTERGOVERNMENTAL TRANSFER
WITH PARTNERSHIP HEALTHPLAN
OF CALIFORNIA
WHEREAS, since 2006, the California Department of Health Care Services (DHCS) has
offered local governments that provide health care the opportunity to secure additional Medi -Cal
revenues by participating in a voluntary Intergovernmental Transfer (IGT) program with their
local Medi -Cal managed care plan; and
WHEREAS, Partnership HealthPlan of California (PHC), is a non - profit community-
based healthcare organization that contracts with the State to administer additional Medi -Cal
revenues to public ambulance providers (i.e., Petaluma Fire Department) to offset previously
unreimbursed costs for serving Medi -Cal plan members; and
WHEREAS, Partnership HealthPlan of California covers members who currently make
up approximately 80% of HMO - managed Medi -Cal patients and, although the City incurs
significant costs for these types of ambulance transports, it can only contractually bill and expect
payment for a certain amount (i.e., a fixed rate of approximately $150 is received per Medi -Cal
patient whiles costs incurred equal approximately $1,200 per patient); and
WHEREAS, participation in an Intergovernmental Transfer Program represents an
opportunity for local government providers of Medi -Cal services to re -coup a share of their costs
for serving PHC patients, most notably because California tends to pay Plans at the lower end of
the actuarially sound rate range and the Federal government, tapping potentially unclaimed
Federal matches, works to make up the difference by requiring all managed care Plans to be paid
at an actuarially sound rate; and
WHEREAS, an IGT program of this type is a matching program, not a reimbursement
program and, therefore, the Federal government will match the transferred funds, pay half of the
Plan's rate increases and, in the end, the local entity receives its own funding plus the Federal
match in return; and
WHEREAS, PHC's role is to collect and submit data to DHCS on each entity interested
in participating in the IGT and to assist each participating entity with the terms governing the
Program and use of newly received revenue; and
WHEREAS, PHC, as the agent for DHCS, has determined that the City of Petaluma
shall transfer funds equal to $104,921 to DHCS pursuant to section 14164 and 14301.4 of the
Welfare and Institutions Code in order to receive net new funds totaling $82,576 in the form of a
lump sum amount of supplemental Medi -Cal revenues (or $187,497 back in return); and
WHEREAS, the up -fiont funds required from the City of Petaluma can be garnered from
general tax revenues, patient fees or agency reserves made up of a combination of sources and
while the total amount of PHC's payment back to the provider is considered Medi -Cal revenue
and must be used for health care services, the funds do not need to be Medi -Cal services
provided exclusively to Medi -Cal patients and funds do not have to be expended in the year
received.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Petaluma, as follows:
1. The proposed agreement with the California Department of Health Care Services
(DHCS) for Intergovernmental Transfer (IGT) in order to increase Medi -Cal
reimbursement for EMS ambulance transport services previously provided to Partnership
Health Plan's members in FY 2013 -14 and which will result in transfer of local
matchable funds to the State in the summer of 2015, 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.
2. The proposed agreement with the California Department of Health Care Services
(DHCS) for Intergovernmental Transfer Assessment Fee will result in payment of a 20%
fee to DHCS which is a condition of participating in the IGT, attached to this resolution
as Exhibit B, is hereby approved and the City Manager is authorized to sign the
agreement on behalf of the City.
EXHIBIT A
CONTRACT #13 -90529
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 Petaluma with respect to the matters set forth below.
RECITALS
A. This Agreement is made pursuant to the authority of Welfare & Institutions Code, section
14164 and 14301.4.
B. The Partnership HealthPlan of California is a County Organized Health 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. Partnership HealthPlan of
California 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 Partnership HealthPlan of California 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
Transfer of Public Funds
1.1 The City of Petaluma shall transfer funds to DHCS pursuant to section 14164 and
14301.4 of the Welfare and Institutions Code, up to a maximum total amount of One hundred four
thousand nine hundred twenty -one dollars ($104,921), to be used solely as a portion of the nonfederal
share of actuarially sound Medi -Cal managed care capitation rate increases for Partnership HealthPlan of
California for the period July 1, 2013 through June 30, 2014 as described in section 2.2 below. The funds
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shall be transferred in accordance with a mutually agreed upon schedule between the City of Petaluma
and DHCS, in the amounts specified therein.
1.2 The City of Petaluma 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 City of Petaluma 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 City of Petaluma 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
Partnership HealthPlan of California as part of Partnership HealthPlan of California's capitation rates for
the period July 1, 2013 through June 30, 2014. The rate increases paid under section 2.2 shall be used for
payments related to Medi -Cal services rendered to Medi -Cal 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 Partnership HealthPlan of California.
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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 the City of Petaluma or federal
matching funds will be recycled back to the City of Petaluma'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 City of Petaluma and Partnership HealthPlan of California of the
amount of the Medi -Cal managed care capitation rate increases that DHCS paid to Partnership HealthPlan
of California 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 City of Petaluma pursuant to this
Agreement is not expended for the specified rate increases under Section 2.2, DHCS shall return the
unexpended funds to the City of Petaluma.
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.
3.2 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
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is
CONTRACT #13 -90529
States first class, certified or registered mail with postage prepaid, addressed to the other party at the
address set forth below:
To the City of Petaluma:
John Brown, City Manager
City of Petaluma
11 English Street
Petaluma, CA 94952
With copies to:
To DHCS:
Dave Kahn, Battalion Chief
Petaluma Fire Department
198 D. Street
Petaluma, CA 94952
Sandra Dixon
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., Suite 71 -4002
MS 4413
Sacramento, CA 95814
Other Provisions
5.1 This Agreement contains the entire Agreement between the parties with respect to
the Medi -Cal rate increases for Partnership HealthPlan of California described in section 2.2 that are
funded by the City of Petaluma and supersedes any previous or contemporaneous oral or written
proposals, statements, discussions, negotiations or other agreements between the City of Petaluma 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
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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.
5.6 Each party hereby represents that the person(s) executing this Agreement on its
behalf is duly authorized to do so.
6. 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.
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, 2013 and shall expire as of June 30,
2016 unless terminated earlier by mutual agreement of the parties.
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SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of
the last signature below.
City of Petaluma
IN
John Brown, City Manager, City of Petaluma
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
C
Date:
Meredith Wurden, Assistant Deputy Director, Health Care Financing
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EXHIBIT B
CONTRACT #13 -90554
INTERGOVERNMENTAL TRANSFER ASSESSMENT FEE
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF HEALTH CARE
SERVICES ( "State DHCS ") and the City of Petaluma 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 The City of Petaluma 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 13- 90529, 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 Partnership HealthPlan of California ( "PHC ") for the
period of July 1, 2013 through June 30, 2014.
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 PHC.
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2. Intergovernmental Transfer Assessment Fee
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, City of Petaluma, 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 City of Petaluma.
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3. 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 transferring 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.
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SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of the last
signature below.
City of Petaluma
John Brown, City Manager, City of Petaluma
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
:A
Date:
Meredith Wurden, Assistant Deputy Director, Health Care Financing
M
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