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HomeMy WebLinkAboutResolution 2018-119 N.C.S. 07/16/2018Resolution No. 2018-119 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 hltergovernmental 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 and 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 $393,094 to DHCS as the Provider Contribution and $78,618.80 as the DHCH Administrative Fee pursuant to section 14164 and 14301.4 of the Welfare and Institutions Code in order to receive estimated net new fiends totaling $330,000 in the form of a lump sum amount of supplemental Medi -Cal revenues for the rate period of FY 2017/18; 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 Resolution No. 2018-119 N.C.S. Page 1 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: I, The proposed agreement with the California Department of Health Care Services for Intergovernmental Transfer in order to increase Medi -Cal reimbursement for EMS ambulance transport services previously provided to Partnership Health Plan's members in FY 2017/18 and which will result in transfer of local matchable funds to the State in late 2018, 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. 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 ,Aprove¢ a to Council of the City of Petaluma at a Regular meeting on the 161h day of July 2018, form: by the following vote: i\ City,tt6rney AYES: Albertson, Barrett, Mayor Glass, Vice Mayor Healy, Kearney, King, Miller NOES: None ABSENT: None ABSTAIN: None _a r ATTEST: City Clerkayor Resolution No. 2018-119 N.C.S. Page 2 EXHIBIT A CONTRACT # 17-94793 CONTRACT 417-94,793 tNTERGOVERINMENTAL AGREEMENT REGARDING TRANSFER Of PUBLIC FUNDS This Agreement 1,; entered into betwe�o.n the CALIFORNIA DEPARTMENT OF I-1EALTI-[ CARE SERVICES ("DI-ICS")and the CIT'; OF PETALUMA FIRE DEPARTNIENT (GOVERNMENTAL FUNDING ENTITYwith respect to the matters set forth belaw- The parties: agree as follwivs- AGREEMENT Transfer 0fPublic FLUNk 1.1 The GOVERNIMENTAL FUNDING ENTITY ources to make transfer of funs to DIICS pursuant tos-octioni 14164 and 14301.4 of flie Weltlare and Institutions Code. The 0111OL111t transferred sliall be based on the sum of the. following rate, calegory per member Ni - month (PNIMI) contribution increments multiplied by menibc.i- months: Funding Entity: city or Petaluma Fire Department Health Plan, Partnership Rating Region, Sonoma Eslimated v,Wnbution Estimaled Con flibution (Non= Rate Category Ph P1.1 rd ember Months Federal Share) Child - non MG111P S0,14 344,63117 S Child - MCHIP 3 0.03 221,1389 S 6,657 Adult - non MCHIP 5 0-55 160,5155 S 02,705 kdult . M,6H- 10 -0-113, —5J411 $- SPD S 1,72 75,596 S t30,024 SIDFull—bLial $ 0,26 2-02 --T3�8 �41 1 1,153 S 35,907 S 2,329'� BC TP LTC 7-21 319 5 2, 2H LTC Full Duals 4,10 11,832 40,500 0 ian a ' 7 pt I Expansion 71201 7 - 12;2017 S OAG 197,207 S 11,832 r20i 8 - 612018 S 0,07 196,439 S 13,751 -1 Estimated Total 1, 3,31,113 45 �393,01 Template Vmslon- 3j"2018 Resolution No. 2018-119 N.C.S. Page 3 CONTRACT Pt 17-94793 The GOVERNNAENTAL FUNDING ENTITY agrees to initially transfer aniounts that tyre calculated usiqj the Estimated Member Months in the chart above, which will be reconciled to actual ciirollment For the, service period ot'July 1, 20 17 through June 30, 20 HS in accordance with Sub -Section I _31 of this Agreement. The ffinds transferred shall NO used as described in Sulam Section '22 of this A_p-coment. The fund,, shall be ftansferred in accordance with the. terms and conditions, including schedule anal amount, established by DHCS. 1.2) The GOVERN IMENTA L FUNDING EN-rITY sliall certif,,r that the funds transferred qualify for Federal Financial Participation pursuant to 42 C,F-R_ part 433, subpart B, -nirces such as recycled Malicaid payments, Federal and are not derived from impermissible sc I money excluded from use, as Stale match, incl-yoramsible lases,, and ntmi-I:Kina fide provider - related donations. Imperni1ssible, sour -es do not include patient care or other revenue. received from programs such as Medicare or iMedicaid to the extent that the program revenue is not obliViated to the State as the source of funding, I L3 DHCS shall reconcile the "EstiniaLedX-lember Months." in Sub -Section 1. I of this Agreement, to actualearollnient in HEALTH PLAN(S) 1`6r the ser} ce period of July 1, 2017 through JIM-, 30. 2018 using actual CrIT011111CM1 figures taken from DHCS records. Enrollment reconciliation will occur on an ongoing basis as updated enrollment figures become considered finat two years, after June 30,101,9. If ava able. ActualciirolltiicjitfigLircs��,I L this reconciliation results in an increase to the total amount necessary to fund the, nonfederal share of the payments. described in SUb-Scdlon 2-2, the, GOVERN M ENT.�%L 17UNDING ENTITY a,gr Lmy additional I rees to LT-1,11SIC ddiL onal funds accessary to cover the ditTereace- If this reconciliation r0SL1tt.,' in a decrease to the total amount necosian, to fund the nonfiederal share of the pa}jiieiits described in Sub-Sk-mion .1'2, DI -ICS agrees to reIL11-11 the urtexpended funds to the Template Version- 31.2018 Resolution No. 2018-119 N.C.S. Page 4 CONTRACT hi17 -94793 GOVERNMENTAL FUNDING ENTITY. If DHCS and the GOVERNMENTAL FUNDING ENTITY mutually agree, amOLMIS (11.10 to or owal by the GOVERN -MENTAL FUNDING ENTITY may be offiet against fulure transfers. 2. Acceplatice and Use of Transferred Funds 11 DUCS Shall eXerckea its U1.1thorliv under section 14164 of the Welfare and Institutions Code io accept funds transferred by the GOVERNNIENTAL FUNDING ENTITY pUriliallt to this Agreement as, IGTs, to use for the purpose set forth in Sub -Section 2-1. The funds transferred by the, GOVERNMENTAL FUNDING ENTITY pLirstiant to Section I of this Agreement shall be used to fund the non-federal share ol­Medi-Cal Managed Care actuarially sound. capitation rates dmribed in section 14301,44,h)(4) of the Welfare and Institutions Code as reflected in the contribution PMPIM and rate categories, reficoed in the ch art set forth In SLlh-SCCtlon 1. 1 . The funds transCerred shall be paid, together with the relawd Federal Financial Part impafion, by DH 'S to HEALTH I'LAN(S) as part of I 1EALTH PLAN(S)' capitation Tates for the service Ixriod of July 1, 2017 through June 30, 21018, In accordance With Section 14301A ofthe Welfare and Inifitutions Code. 2.; DHCS sliall seCk Federal Financial Participation for the capitation rates spc�eified in Sidi -Section 2.2 to the full extent Iv.rmitted bV federal law. IA The parties acknowledge that Df ICS wilt obtain any neecssdry approvals from the Centers, f,)r Nledicare and Medicaid Services. 15 OHCS shall not direct HEALTH PLAN(S)' eximiditure of the lm.ynienu received PLU-SlIant to Sub -Section 2.2. 3, Assessment FCC Template Version- -1210 18 Resolution No. 2018-119 N.C.S. Page 5 CONTRACT H 17-94793 I DHCS shall exercise its authority under section 14301.4 of the Welfare and Institutions Code to assess a 20 percent fee related to the amounts transferred PUTNSUaIll to Section I orthisA-greement, except as provided In SLIb-Section 1-1. GOVERNMENTAL FUNDING ENTITY agrees to pay the full allIOUIlt ofthat assessment in addition to the funds transferred punLlailll to S06011 I rat'i11is Agreement. The 20 -percent assessment fee' shall not be applied to any INartion of funds transferred pursuant to Section I tha! are. exempt in accordance with sections 1430 1.4(d) or 14301.5(b)(4) of the WcIt'Llic and Institutions Code. DHCS shall have sole discretion to detenillne the amount of the funds transferred PUrSUallL to Section I that NN111 not be subjeet to a 20 1-yorcent fee. DHCS has determined that SO.00 of the trans.Cor arnounts,%vitl not tv assessed a 20 percent feo, sukiect to Sub -Section 3.3. 3-3 The20-percentassessrnent CCC lAirsuant to this Agreement is non- refundable and shall be wired to DHCS separately frorn and simultancous to, the transfer amount s made under Section I of this Agreenicrit. If, at !he. time of lhe, reconciliation perromled Pursuant to Sub -Section 1.3 oCtlils Agreement, there Is a clumpe in the .1111011111 transferred that is sijb�jev to the 20-porcent assessment in accordance, with Sul -Section 3. 1, then I proportional aqjustment to the assessment fee will. be made. 4. Amendments 4J No aniondment or modifiulion to this Agreement shall be binding on either 1 -arty unless made in writing Lind exectited by I-oth parties, 4,2 The parties shall negotiate In good faith to ailiend this Agreement as necessary and appropriate to Implement the requirements set Forth in Section 2 of this Aurcornent. 4 Template Version- -12018 Resolution No. 2018-119 N.C.S. Page 6 CONTRAC*r H'I 7-94793 Nofice.s. Any and all notices required. pci-milled or desired to be given li-orcunder by one, parry to the. othersliall be, in writing and shall be delivered to the other party personally or by United Mate; First Class, Certified or Registered mail wilh postage propmald, addressed to the other party at the address sit forth below: To the GOVERNNIENTAL FUNDING ENTITY: Jelin C. Brown. City tMaii-ager Cite Of PetalUrnil I I Engfiih Street Petal L11112, CA 9495? With copioi to: David Kalin, Battalion Chief -EMS PQW111111.1 Fire Deparvient I 9S', D StreQ.1 Pet rltu11a. CA 94952 and Corey Garberollo, Financo. Director City of Petaluma I I hagfish Street Pe,WIL11111), CA 949-52 Coarberokoki"ci. let'l I II ma'C'mis and Carolyn Stewart Senior Director of Financial Analysis Partnership I kahliPlan of Calico is 4665 Business Center Drive Fair tela. CA Q4534 Template Version- j"201 S Resolution No. 2018-119 N.C.S. Page 7 CONTRACT H 17-94,793 To DFfCS-, Sandra Dixon California Department ofl-lealill Care, Services Capitated Rates Development Division 1501 Capitol Ave., Suite 71-4002 ,IS 441 Sacramento, CA 95814 6. Other Provisions 6.1 This Agreement contains the entire Agreement between the. parties with resIv,?,et to the Xledt-Cal payments described in Sub -Section 22 of this Agreement that are funded by the GOVERN MENTAL FUNDING ENTITY, and sulv.rsedes any previous. or contemporaneous oral or written proposals, SlatCnlentS, (IISCLPS'SiODSnegotiations or other agreements. between the GOVERNMENTAL FUNDING E'NTITY and DF[CS relating to the subject matter oaf this Agmcenient. Tliis Agreement is not, however, intended to be the sole , a, areement behveea the parties on matters relating to the funding and administration of the, -N-k-dt- Cal pro rani. This Agreement shall not modify the terms ofaiiy other agreement, existing or entenod into in the. future, between the, parties. 6.2 The non-enforcemeaL or other WaiN'C1-,0f.-111)1 provision of this Agreement shall not be const rtwd as a conLi nu i n L, , waiver or as a waiver of any other provision of this Agreement. 6 . 3' Sections 2 and 3 of this Agreement :Shall iiwvive the expiration or tenuiriation of this Agreement - 6.4 Nolhing in this Agreement is intended to confor any rights or rernedies on I any thiI irpar y, including. without limitation, anv provider(s) or groups of providers, or any nuht I . I - 6 Template version- 2:"20I S Resolution No. 2018-119 N.C.S. Page 8 CONTRACT Pt 17-94793 to medical sei-,,iccs for any individual(s) or groups of individuals. Accordingly, there shall be no third party beneficiary of this AL, ement. ().i Time isol'the essence in this Agreement, 66 Each party hereby represents that the personfs) executing this Agreeniont on its behalf is duly aL1t1101'iZCJ to do so. -1, -es� in this Agreenicnt StiilcAiitiiciritv.Excel.itase.xpi ilyproN,idc!dlier,,In,tiotliiilg shall be construed to limit, restrict, or modify the DHCS' powers, authorities, and duties under Federal zinc] State law and rquilaticins. S. Approval, This Agmoment is of no force and effiect until signed by the parties. 9. 1'erm, This Acreement shall be effective as of July I. 2017 and shall expire as of December 3 1, 2020 unless terrninaLed earlier by 111LItual attre.ement, of the parties, I - SIGNATURES IN WITNESS WHEREOF, the parties here -to have executed this Agreement, on the date of the Iasi sipjnziture below. 1'H' CITY OF PETALUMA: By: John C. Brown, City Manager Date: THE STATE OF CALIFORNIA. DEPARTIMENT OF HEALTH CARE SERVICES: Byi Date: Jennifer Lopez, Acting Division Chief, Capitated Rates DevelolMilent, Division 7 Template Version- 3f"201 S Resolution No. 2018-119 N.C.S. Page 9