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HomeMy WebLinkAboutResolution 2019-097 N.C.S. 07/01/2019Resolution No. 2019-097 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 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 $371,959 to DHCS as the Provider Contribution and $74,392 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 funds totaling $330,000 in the form of a lump sum amount of supplemental Medi -Cal revenues for the rate period of FY 2018/19; 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 Resolution No. 2019-097 N.C.S. Page 1 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 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 2018/19, which will result in the transfer of local matchable funds to the State in late 2019, and is attached to this resolution as Exhibit A, is hereby approved and the City Manager is authorized to sign the agreement and any necessary related documents 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 theppr ed as to Council of the City of Petaluma at a Regular meeting on the I st day of July 2019, orn: by the following vote: Cityttorney AYES: Mayor Barrett; Fischer; Healy; Kearney; King; Vice Mayor McDonnell; Miller NOES: None ABSENT: None ABSTAIN: None ATTEST Acting City Clerk Mayor Resolution No. 2019-097 N.C.S. Page 2 CON'T'RACT t118-95609 INTERGOVERNMENTAL A.G:REE(VIEN'I' RIPGARDING TRANSFER OF PIJ13LIC FUNDS This Agreement is entered into between the CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES ("DHCS") and the CITY OF PETALUMA FIRE DEPARTMENT (GOVERNMENTAL FUNDING ENTI'T'Y) with respect to the matters set forth below. Hie parties agree as follows: AGREEMENT Transfer ofPublic Funds 1.1 The GOVERNMENTAL, FUNDING ENTITY agrees to make a transfer of funds to DHCS pursuant to sections 14164 and 14301.4 of the Welfare and Institutions Code. The amount transferred shall be based on the sum of the applicable rate category per member per month (PMPM) contribution increments multiplied by member months, as reflected in Exhibit 1. The GOVERNMENTAL FUNDING ENTITY agrees to initially transfer amounts that are calculated using the Estimated Member Months in Exhibit 1, which will be reconciled to actual enrollment for the service period of July 1, 2018 through June 30, 2019 in accordance with Sub - Section 1.3 of this Agreement. The finds transferred shall be used as described in Sub -Section 2.2 of this Agreement. The funds shall be transferred in accordance with the terms and conditions, including schedule and amount, established by DIICS. 1.2 The GOVERNMENTAL FUNDING ENTITY shall certify that the fiwds transferred qualify for Federal Financial Participation pursuant to 42 C.F.R. hart 433, subpart R, 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 - Template Version- 712018 Exhibit A Resolution No. 2019-097 N.C.S. Page 3 CONTRACT 1118-95609 related donations. 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 finding. 1,3 DHCS shall reconcile the "Estimated Member Months," in Exhibit 1, to actual ervollment in HEALTI,I PLAN(S) for the service period of July 1, 2018 through June 30, 2019 using actual enrollment figures taken fromDHCS records. Enrollment reconciliation will occur on an ongoing basis as updated enrollment figures become available. Actual enrollment figures will be considered final two years after June 30, 2019, If this reconciliation results in an increase to the total amount necessary to fund the nonfederal share of the payments described in Sub -Section 2.2, the GOVERNMENTAL FUNllING ENTITY agrees to transfer any additional fluids necessary to cover the difference. If this reconcitiation results in a decrease to the total amount necessary to fund the nonfederal share of the payments described in Sub -Section 2.2, DIICS agrees to return the unexpended funds to the GOVERNMENTAL FUNDING ENTITY. If DHCS and the GOVERNMENTAL FUNDING ENTITY mutually agree, amounts due to or owed by the GOVERNMENTAL FUNDING ENTITY may be offset against inure transfers. 2. Acceptance and Use of Transferred Funds 2.1 DHCS shall exercise its authority under section 14164 of the Welfare and Institutions Code to accept fiends transferred by the GOVERNMENTAL FUNDING ENTITY pursuant to this Agreement as IGTs, to use for the purpose set forth in Sub -Section 2,2, 2,2. The funds transferred by the GOVERNMENTAL. FUNDING ENTITY pursuant to Section 1 and Exhibit '1 of this Agreement shall be used to fund the non-federal share of Medi -Cal Managed Care actuarially sound capitation rates described in section 14301.4(b)(4) of the Welfare and Institutions Code as reflected in the contribution PMPM and rate categories Template Version- 7/2018 2 Resolution No. 2019-097 N.C.S. Page 4 CON"TRACT #18-95609 reflected in Exhibit 1. The funds transferred shall be paid, together with the related Federal Financial Participation, by DHCS to HEALTH PLAN(S) as part of HEALTH PLAN(S)' capitation rates for the service period of July I, 2018 through ,lune 30, 2019, in accordance with section 14301.4 of the Welfare and Institutions Code, 2.3 DHCS shall seek Federal financial Participation for the capitation rates specified in Sub -Section 2.2 to the full extent permitted by federal law. 2.4 The parties acknowledge that MICS will obtain any necessary approvals from the Centers for Medicare and Medicaid Services. 2.5 DHCS shall not direct HEAM-1 PLAN(S)' expenditure of the payments received pursuant to Sub -Section 2.2. 3. Assessment Fee 3.1 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 pursuant to Section 1 of this Agreement, except as provided in Sub -Section .3.2. GOVERNMENTAL FUNDING ENTITY agrees to pay the full amount of that assessment in addition to the fiords transferred pursuant to Section 1 of this Agreement. 3.2 The 20 -percent assessment fee shall not be applied to any portion of funds transferred pursuant to Section 1 that are exempt in accordance with sections 14301.4(d) or 14301.5(b)(4) of the Welfare and Institutions Code. DHCS shall have sole discretion to determine the amount of the fiords transferred pursuant to Section I that will not be subject to a 20 percent fee. DII.CS has determined that $0.00 of the transfer amounts will not be assessed a 20 percent fee, subject to Sub -Section 3.3. Template Version- 7/2018 3 Resolution No. 2019-097 N.C.S. Page 5 CONTRACT #18-95609 3.3 The 20 -percent assessment fee pursuant to this Agreement is non- refundable and shall be wired to DI WS separately from, and simultaneous to, the transfer amounts made under Section 1 of this Agreement. If at the time of the reconciliation performed pursuant to Sub -Section 1.3 of this Agreement, there is a change iu the amount transferred that is subJect to the 20 -percent assessment in accordance with Sub -Section 3. 1, then a proportional adjustment to the assessment fee will be niadc. 4, Amendments 4,1 No amendment or modification to this Agreement shall be binding on either party unless made in writing and executed by both parties, 4.2 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. 5, Notices. Any and all notices required, permitted or desired to be given hereunder by one pally to the other shall be in writing and shall be delivered to the other party personally or by United Statcs Hirst Class, Certified or Registered mail with postage prepaid, addressed to the other party at the address set forth below: To the GOVERNMENTAL FUNDING ENTITY: Peggy Flynn, City Manager City of Petaluma I 1 English Street Petaluma, CA 94952 pftynn a cityoft)etaluma,org With copies to: Template Version- 7/2018 4 Resolution No. 2019-097 N.C.S. Page 6 CONTRACT It18-95609 To DI -ICS: Jeff Schach, Assistant Fire Chief Petaluma Fire Department 198 D Street Petaluma, CA 94952 jschach a cityfpetaluma.org and Corey Garberolio, Finance Director City of Petaluma 11 English Street Petaluma, CA 94952 cgarbero rt ciiyo1j)etaluma.or� and Jeff Ingram, Director, FP&A Partnership I IealthPlan of California 4665 Business Center Drive Fairfield, CA 94534 'in ram ti artnershiphp.org Sandia Dixon California Depailment of Health Care Services Capitated Rates Development Division 1501 Capitol Ave., Suite 71-4002 MS 4413 Sacramento, CA 95814 S�aicira.Dixon �i)cihcs.ca.ggN, 6. Other Provisions 6.1 This Agreement contains the entire Agreement between the parties with respect to the Medi -Cal payments described in Sub -Section 2.2 of this Agreement 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 relating to the Template Version- 7/2018 Resolution No. 2019-097 N.C.S. Page 7 CONTRACT1118-95609 subject matter of this Agreement. This Agreement is not, however, intended to be the sole agreement between the parties on matters relating to the fundingand administration of the Medi - Cal program. This Agreement shall not modify the terms of any other agreement, existing or entered into in the future, between the parties. 6.2 The non-enl'orcernent or other waiver of any provision of this Agreement shill not be construed as a continuing waiver or as a waiver of any other provision of this Agreement. 6.3 Sections 2 and 3 of this Agreement shall survive the expiration or termination of this Agreement. 6A 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. 6.5 Time is of the essence in this Agreement. 6.6 Lach party hereby represents that the person(s) executing this Agreement on its behalf is duly authorized to do so. 7. State Authority. Except as expressly provided herein, nothing in this Agreement shall be construed to limit, restrict, or modify the Dl-1CS' powers, authorities, and duties under Federal and State law and regulations. 8. Approval. This Agreement is of no force and effect until signed by the parties. 9. Term. This Agreement shall be effective as of July 1, 2018 and shall expire as of December 31, 2021 unless terminated earlier by mutual agreement of the parties. Template Version- 7/2018 6 Resolution No. 2019-097 N.C.S. Page 8 CONTRACT # 18-95609 SIGNATURES TN WITNESS WHFREOF, the parties hereto have executed this Agreement, on the date of the last signature below, THE CITY OF PETALUMA FIRE DEPARTMENT: By: Peggy Flynn, City Manager, City of Petaluma Date: THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTII CARE SERVICES: By: Date: Jeiunifer Lopez, Division Chief, Capitated Rates Development Division Template Version- 7/2018 Resolution No. 2019-097 N.C.S. Page 9 CONTRACT// 18-95609 r"Alibit 1. Funding Entity: jcity orPetaiuma Fire 1)ehaifinent Health Plan: kPamnersWI) Health Plan Rating Region: INorthern Region Rate Category Contribution PMPM Estimated Member Months Estimated Contribution (Non - Federal Share) Child - non MCHIP $ 0,04 1,053,493 $ 42,140 Child - MCHIP $ 0.01 439,588 $ 4,396 Adult - non MCI -UP $ 0.14 563,208 $ 78,849 Adult - WHIP $ 0,02 11,019 $ 220 SPD $ 0,43 296,959 $ 127,692 SPD/Frill-DLOI $ 0.07 468,766 $ 32,814 BCC'I'P $ 0.59 2,387 $ 1,408 LTC $ 1,60 655 $ 1,048 LTC/Frill-Dual $ 1,31 24,163 $ 31,654 Whole Child Model $ 1.00 28,034 $ 28,034 Optional Expansion $ 0,02 1,185,175 $ 23,704 Estimated Total 4,073,447 $ 371,959 Template Version- 7/2018 Resolution No. 2019-097 N.C.S. Page 10