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HomeMy WebLinkAboutResolution 2015-183 N.C.S. 12/07/2015Resolution No. 2015 -183 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 47.35% of GEMT service billings for 2014), 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, as a Medi - Cal - enrolled, public agency GEMT service provider, the City of Petaluma is eligible to participate in the Program, and has already re- couped over $77,339 in reimbursement by participating in this program during the period January 30, 2010 through June 30, 2014; and WHEREAS, by participating in the Program, the City may receive additional similar reimbursement for GEMT services thereby reducing the City's unreimbursed GEMT service costs for the period July 1, 2014 through June 30, 2017; and WHEREAS, the State has entered into an agreement with the Sacramento Metropolitan Fire District to administer the Program, including providing reimbursements to eligible participant GEMT agencies and recovering from such agencies costs of administering the Program incurred by the State and Sacramento Metropolitan Fire District; and Resolution No. 2015 -183 N.C.S. Page 1 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. REFERENCE: AYES: NOES: ABSENT: ABSTAIN ATTEST: Under the power and authority conferred upon this Council by the Charter of said City. I hereby certify the foregoing Resolution was introduced and adopted by the Council of the City of Petaluma at a Regular meeting on the 7th day of December, 2015, by the following vote: Albertson, Barrett, Healy, Kearney, King, Vice Mayor Miller None Mayor Glass None City Clerk City { A t Vice Mayor as to Resolution No. 2015 -183 N.C.S. Page 2 EXHIBIT "A" 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 ( "State Code ") and State Plan Amendments ( "SPA ") 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 the State Code and SPA 09 -024 ( "State Agreement '), which is attached hereto as Exhibit A, and is incorporated as if set forth fully herein; and, WHEREAS under the State Code an eligible provider of ground emergency medical transportation services may be entitled to supplemental' Medi -Cal reimbursement as set forth in those provisions; and, WHEREAS an eligible provider as 'described in the State Code is required to enter into an agreement to reimburse the State for implementing and administering the Supplemental Reimbursement Program as a condition of receiving supplemental reimbursement pursuant to *the State Code; and, WHEREAS pursuant to the State Agreement, Metro Fire has been designated by the State to recover the administrative and implementation costs required to be paid by eligible providers under the State Code; 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 Agreement for the purpose of setting forth the manner -and terms for payment of administrative costs by the eligible GEMT providers to Metro Fire, under the following terms and conditions. Page 9 of 5 Resolution No. 2015 -183 N.C.S. Page 3 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 seven (7) years C. Provide all records upon request for audit purposes V. PAYMENT TERMS GEMT Transporter agrees to pay Metro Fire the transporter's share of the State administrative costs as defined in the State Code. The GEMT transporter share will be based upon the administrative costs per fee for service Medi -Cal transport, multiplied by the GEMT Transporters 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 of GEMT services under the State Code 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 from GEMT Transporters. A. Metro Fire will notify, via email, the amount due under Section V. of this Agreement by the GEMT Transporter once the amount is determined. B. All amounts due under this Agreement will be paid to Metro Fire no later than 30 days after the first notification is sent to the GEMT Transporter. C. Non- payment by the GEMT Transporter constitutes a breach of this Agreement and, if not cured, will result in a termination of this Agreement pursuant to Section XII below, 1. A breach of this Agreement may be cured by the successful completion of the payment transaction to Metro Fire by GEMT Transporter within 30 days' notice by Metro Fire. 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, VI. REIMBURSEMENT COSTS ACKNOWLEDGMENT The GEMT Transporter acknowledges and agrees that the compensation paid to Metro Fire pursuant to this Agreement is intended to cover the costs for administering the supplemental reimbursement program under Section 14105.94(d) of the State Code. Page 3 of 5 Resolution No. 2015 -183 N.C.S. Page 4 The compensation payable to Metro Fire is approved by the State, pursuant to the State Agreement 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 Section 14105.94(d) of the State Code, in the manner set 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 Section X. Or it shall be terminated. 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 be construed as a waiver of any other default, breach or condition precedent, or any other right hereunder. Page 4 of 5 Resolution No. 2015 -183 N.C.S. Page 5 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 Agreement 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. SACRAMENTO METROPOLITAN FIRE DISTRICT Signature: Amanda Thomas, Chief Financial Officer Date GEMT Transporter Signature: Name: Title: Date Page 5 of 5 Resolution No. 2015 -183 N.C.S. Page 6