HomeMy WebLinkAboutStaff Report 3.A 05/15/2017DATE: May 15, 2017
Agenda Item #3.A
TO: Honorable Mayor and Members of the City C it through the City Manager
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FROM: Leonard C. Thompson, Fire Chief
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 health care 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- covered Medi -Cal patients who are treated and transported
by City of Petaluma ambulances. IGTs offer a way for entities like Petaluma to receive
additional Medi -Cal funds for ambulance services provided to PHC beneficiaries. 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. Local governments
volunteer to participate in these IGTS; no entity is required to participate.
Last year signified Petaluma's second year participating in the program and, by carefully
following DHCS' guidelines, funds were received, per City Council approval on May 16, 2016
(Resolution #16 -064 N.C.S.), from transports made during FY 2014 -15. This year will mark the
third year participating and positive results are expected, as described in the Financial section
below.
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. 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. 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. This is a matching program
requiring money up front to demonstrate what has been "spent" on Medi -Cal patients. Those
matching funds, amounts that are different every year based on provider transport statistics, are
returned back to the provider along with the new net funds fiom DHCS. Essentially, the local
entity has its initial funding returned, along with the Federal match.
The total amount of PHC's payment to the provider is considered Medi -Cal revenue. Pursuant to
the terns 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, however, 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. The new funds also do not have to be expended in the year received. Revenues may be
used to operate existing EMS services, such as what occurred with funding received in the first
participating year, or to support new or improved health care programs and services.
Revenue from the third round of the program will support the purchase of new, state -of -the -art
power gurneys for the medic units, expensive pieces of essential equipment which will ultimately
provide lift relief to the medics on the street and help prevent back injuries. The purchase of the
corresponding power load tracking system, a device that is built into the floor of the medic unit
and locks onto the gurney to pull it into the back of the ambulance, requiring very little effort and
strength from the crew members, would be another desired purchase. If funds remain,
purchasing advanced Automatic External Defibrillators for the medic units would also fill a
need.
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FINANCIAL IMPACTS
As stated earlier, this is the third year that Petaluma will have participated in this program. Last
year, the net new funds were anticipated to be $188,071; in fact, $158,061.39 was received due
to a recalculation of rates during the process by DHCS that reduced all participant amounts in
some way. This year, the program will cover two rate periods: FY 2015/16 and FY 2016/17.
PHC has determined that the City of Petaluma will need to transfer funds equal to $433,507 from
the General Fund as the Provider Contribution and $86,702 as the Administrative Fee to DHCS,
pursuant to sections 14164 and 14301.4 of the Welfare and Institutions Code. In return, the City
will receive net new funds totaling $371,573 in the form of a lump sum payment back to the City
in the amount of $891,782 in supplemental Medi -Cal revenues. These figures were derived from
research completed by PHC based on documentation provided by Petaluma Fire for these two
stated rate periods and is further broken down below:
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. Net funds in excess of the originating payment may be budgeted for
Fire Department use to be put towards the purchase of emergency medical devices, such as new
gurneys, or other costly equipment. Medi -Cal is a major source of payment for locally provided
ambulance services; receiving reimbursement for the true cost of that care can only benefit 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
Transfer to
Fund the IGT
DHCS 20%
Admin Fee
New Net
Funds
Total Funds to
be Received
FY 2015/16
$204,864
$40,973
$173,940
$419,777
FY 2016/17
$228,643
$45,729
$197,633
$472,005
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. Net funds in excess of the originating payment may be budgeted for
Fire Department use to be put towards the purchase of emergency medical devices, such as new
gurneys, or other costly equipment. Medi -Cal is a major source of payment for locally provided
ambulance services; receiving reimbursement for the true cost of that care can only benefit 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
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 $204,864 to DHCS as the Provider Contribution and $40,973 as the
DHCH Administrative Fee pursuant to section 14164 and 14301.4 of the Welfare and Institutions
Code in order to receive net new funds. totaling $173,940 in the form of a lump sum amount of
supplemental Medi -Cal revenues (or $419,777 back in return) for the rate period of FY 2015/16;
and
WHEREAS, PHC, as the agent for DHCS, has determined that the City of Petaluma
shall transfer funds equal to $228,643 to DHCS as the Provider Contribution and $45,729 as the
DHCH Administrative Fee pursuant to section 14164 and 14301.4 of the Welfare and Institutions
Code in order to receive net new funds totaling $197,633 in the form of a lump sum amount of
supplemental Medi -Cal revenues (or $472,005 back in return) for the rate period of FY 2016/17;
and
WHEREAS, the up -front 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 2015/16 and FY 2016/17 and which will result in transfer
of local matchable funds to the State in the summer of 2017, 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 for each rate period 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.
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EXHIBIT A
CONTRACT # 16 -93689
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 (GOVERNMENTAL FUNDING ENTITY) with respect
to the matters set forth below.
RECITALS
A. This Agreement is made pursuant to the authority of Welfare & Institutions Code, sections
14164 and 14301.4.
B. The Partnership HealthPlan of California (HEALTH PLAN) 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.
HEALTH PLAN 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 HEALTH PLAN 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 GOVERNMENT FUNDING ENTITY shall transfer funds to DHCS pursuant
to sections 14164 and 14301.4 of the Welfare and Institutions Code, up to a maximum total amount of
one hundred eighty -eight thousand two hundred ninety -three dollars ($188,293) for the period of July 1,
2015 through June 30, 2016, and a maximum total amount of two hundred twenty -seven thousand seven
hundred sixty -one dollars ($227,761) for the period of July 1, 2016 through June 30, 2017, to be used
solely as a portion of the nonfederal share of actuarially sound Medi -Cal managed care capitation rate
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EXHIBIT A
CONTRACT # 16 -93689
increases for HEALTH PLAN for the periods of July 1, 2015 through June 30, 2016, and July 1, 2016
through June 30, 2017 as described in section 2.2 below. The funds shall be transferred in accordance
with a mutually agreed upon schedule between the GOVERNMENTAL FUNDING ENTITY and DHCS,
in the amounts specified therein.
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 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 GOVERNMENTAL FUNDING ENTITY 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 GOVERNMENTAL FUNDING ENTITY 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 HEALTH PLAN as part of HEALTH PLAN'S capitation rates for the periods
of July 1, 2015 through June 30, 2016 and July 1, 2016 through June 30, 2017. The rate increases paid
under section 2.2 shall be used for payments related to Medi -Cal services rendered to Medi -Cal
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EXHIBIT A
CONTRACT # 16 -93689
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 HEALTH PLAN.
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 GOVERNMENTAL FUNDING
ENTITY or federal matching funds will be recycled back to the GOVERMENTAL FUNDING
ENTITY'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 GOVERNMENTAL FUNDING ENTITY and HEALTH PLAN of the
amount of the Medi -Cal managed care capitation rate increases that DHCS paid to HEALTH PLAN
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 GOVERNMENTAL FUNDING
ENTITY pursuant to this Agreement is not expended for the specified rate increases under Section 2.2,
DHCS shall return the unexpended funds to the GOVERNMENTAL FUNDING ENTITY.
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.
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EXHIBIT A
CONTRACT # 16 -93689
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
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:
John C. Brown, City Manager
City of Petaluma
11 English Street
Petaluma, CA 92952
jbrown@ci.petaluma.ca.us
With copies to:
David Kahn, Battalion Chief -Fire Administration
Petaluma Fire Department
198 D Street
Petaluma, CA 94952
dkahn@ci.petaluma.ca.us
and
Carolyn Stewart
Senior Director of Financial Analysis
Partnership HealthPlan of California
4665 Business Center Drive
Fairfield, CA 94534
cstewart@partnership.org
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EXHIBIT A
CONTRACT # 16 -93689
To DHCS:
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
5. Other Provisions
5.1 This Agreement contains the entire Agreement between the parties with respect to
the Medi -Cal rate increases for HEALTH PLAN described in section 2.2 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. 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 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.
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CONTRACT # 16 -93689
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. Tenn. This Agreement shall be effective as of July 1, 2015 and shall expire as of
June 30, 2019 unless terminated earlier by mutual agreement of the parties.
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of
the last signature below.
THE CITY OF PETALUMA:
I-
John C. Brown, City Manager, City of Petaluma
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
511
Date:
Jennifer Lopez, Acting Division Chief, Capltated Rates Development Division
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EXHIBIT B
CONTRACT # 16 -93720
INTERGOVERNMENTAL TRANSFER ASSESSMENT FEE
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF HEALTH CARE
SERVICES ( "State DHCS ") and the CITY OF PETALUMA (GOVERNMENTAL FUNDING ENTITY)
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
Transfer of Public Funds
1.1 GOVERNMENTAL FUNDING ENTITY 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 16- 93689, 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 HEALTH PLAN (Partnership
HealthPlan of California) for the periods of July 1, 2015 to June 30, 2016 and July 1, 2016 to June 30,
2017.
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
HEALTH PLAN.
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EXHIBIT B
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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, GOVERNMENTAL FUNDING ENTITY, 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 l 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 GOVERNMENTAL FUNDING ENTITY.
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EXHIBIT B
CONTRACT # 16 -93720
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 GOVERNMENTAL FUNDING 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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EXHIBIT B
CONTRACT # 16 -93720
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of the last
signature below.
THE CITY OF PETALUMA:
C
John C. Brown, City Manager, City of Petaluma
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
wo
Date:
Jennifer Lopez, Acting Division Chief, Capitated Rates Development Division
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