HomeMy WebLinkAboutResolution 2017-062A N.C.S. 05/15/2017Resolution No. 2017 -62A 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 $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
Resolution No, 2017 -062A N.C.S. Page I
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.
Under the power and authority conferred upon this Council by the Charter of said City.
REFERENCE: I hereby certify the foregoing Resolution was introduced and adopted by the Approved
Council of the City of Petaluma at a Regular meeting on the 15`h day of May, 2017, for
by the following vote:
City Attorney
AYES: Albertson, Vice Mayor Barrett, Mayor Glass, Healy, Kearney, King, Miller
NOES: None
ABSENT: None
ABSTAIN: None
ATTEST: -�
City Clerk Pro Tem IVlayor
Resolution No. 2017 -062A N.C.S. Page 2
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 increases for HEALTH PLAN for the
Resolution No. 2017 -062A N.C.S. Page 3
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 beneficiaries. The rate increases
Resolution No. 2017 -062A N.C.S. Page 4
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.
Resolution No. 2017 -062A N.C.S. Page 5
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
estewal,t@partnership.org
Resolution No. 2017 -062A N.C.S. Page 6
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
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.
5.3 Section 2 of this Agreement shall survive the expiration or termination of
this Agreement.
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.
Resolution No. 2017 -062A N.C.S. Page 7
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, 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:
an
John C. Brown, City Manager, City of Petaluma
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
in
Date:
Jennifer Lopez, Acting Division Chief,
Capitated Rates Development Division
Resolution No. 2017 -062A N.C.S. Page 8
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
1. 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.
Resolution No. 2017 -062A N.C.S. I Page 9
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 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 GOVERNMENTAL FUNDING
ENTITY.
Resolution No. 2017 -062A N.C.S. Page 10
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.
Resolution No. 2017 -062A N.C.S. Page 11
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of the
last signature below.
THE CITY OF PETALUMA:
al
John C. Brown, City Manager, City of Petaluma
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
ME
Date:
Jennifer Lopez, Acting Division Chief,
Capitated Rates Development Division
Resolution No. 2017 -062A N.C.S. Page 12