HomeMy WebLinkAboutResolution 2015-074 N.C.S. 06/01/2015Resolution No. 2015 -074 N.C.S.
of the City of Petaluma, California
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 -front funds required from the City of Petaluma can be garnered from
ge • eral 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
Resolution No. 2015 -074 N.C.S. Page 1
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.
Under the power and authority conferred upon this Council by the Charter of said City.
Resolution No. 2015 -074 N.C.S.
Page 2
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 140873, under which Partnership HealthPlan of California arranges and
pays fr i 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
Resolution No, 2015 -074 N.C.S. Page 3
CONTRACT #13 -90529
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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CONTRACT #13 -90529
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.
3. 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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CONTRACT #13 -90529
States first class, certified or registered mail with postage prepaid, addressed to the other party at the
addres,, 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
Resolution No. 2015 -074 N.C.S. Page 6
CONTRACT #13 -90529
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.
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.
Resolution No, 2015 -074 N.C.S. Page 7
CONTRACT #13 -90529
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of
the last signature below.
City of Petaluma
RE
John Brown, City Manager, City of Petaluma
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
IN
Date:
Meredith Wurden, Assistant Deputy Director, Health Care Financing
Resolution No. 2015 -074 N.C.S. Page 8
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
L I 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 ( "PHU) 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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CONTRACT #13 -90554
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; i 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 r,unds.
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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CONTRACT #13 -90554
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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CONTRACT #13 -90554
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:
IC
Date:
Meredith Wurden, Assistant Deputy Director, Health Care Financing
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