HomeMy WebLinkAbout05 - Medi -Cal Managed Care Rate Range Intergovernmental Transfer Program to Increase Reimbursement for Ambulance Transport ServicesQ SEW Pp�T
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c�<,FORN'P City Council Staff Report
July 9, 2019
Agenda Item No. 5
TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM: Chip Duncan, Fire Chief - 949-644-3101, cduncan@nbfd.net
PREPARED BY: Angela Crespi, Administrative Manager, acrespi(cr).nbfd.net
PHONE: 949-644-3352
TITLE: Resolution No. 2019-67: Participation in the Medi -Cal Managed Care
Rate Range Intergovernmental Transfer Program to Increase
Reimbursement for Ambulance Transport Services
ABSTRACT:
The California Department of Health Care Services (DHCS) offers local units of
government that provide health care services 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. CalOptima is a County Organized Health
System (COHS) created by the Orange County Board of Supervisors in 1993 and serves
as the Medi -Cal managed care plan for Orange County. In 2016, CalOptima began
allowing Fire Departments that provide ambulance transport services to participate in the
Medi -Cal Managed Care Rate Range IGT. To date, the City of Newport Beach has
successfully participated in four transactions to secure a total of $603,108 in increased
revenue. Continued participation in the IGT will allow the City to receive additional Federal
funds to offset previously unreimbursed costs for providing transport services to Medi -Cal
plan members during each fiscal year. Participation in the IGT program is on a year -by -
year basis and is currently available for services provided in Fiscal Year 2018-19.
RECOMMENDATION:
a) Determine this action is exempt from the California Environmental Quality Act (CEQA)
pursuant to Sections 15060(c)(2) and 15060(c)(3) of the CEQA Guidelines because
this action will not result in a physical change to the environment, directly or indirectly;
b) Adopt Resolution No. 2019-67, A Resolution of the City Council of the City of Newport
Beach, California, Authorizing the Mayor and City Manager, or Designees, to Execute
Agreements and Amendments with the Department of Health Care Services (DHCS)
and CalOptima to Participate in the Fiscal Year 2018-2019 Medi -Cal Rate Range
Intergovernmental Transfer (IGT) Program; and
c) Approve Budget Amendment No. 20-002CC increasing revenues estimates and
expenditure appropriations related to the Medi -Cal IGT Program. Additional revenues
are estimated at $643,254 in account number 01040404-431246 (Medi -Cal IGT
Program) and increased expenditure appropriations are estimated at $321,768 in
expenditure account number 01040404-821008 (Medi -Cal IGT Program).
5-1
Resolution No. 2019-67: Participation in the Medi -Cal Managed Care Rate Range
Intergovernmental Transfer Program to Increase Reimbursement for
Ambulance Transport Services
July 9, 2019
Page 2
FUNDING REQUIREMENTS:
To participate as a funding entity, the City must transfer local funds up to a maximum total
amount of $268,140 to DHCS through an Intergovernmental Transfer (IGT) along with a
twenty percent assessment fee of $53,628 for administering such Intergovernmental
Transfer. DHCS will then use the local funds provided to draw down additional Federal
funds to access the highest allowable Medi -Cal reimbursement rate from the Federal
Government. The City expects to receive a 100 percent reimbursement from CalOptima,
including the twenty percent assessment fee, as well as $321,486 of new revenue from
the IGT -funded rate increase.
If approved, the Budget Amendment increases revenue estimates by $643,254 from
DHCS distributed by CalOptima and increases expenditure appropriations of $321,768
for a net increase to the General Fund of $321,486.
DISCUSSION:
The City's costs associated with delivering Emergency Medical Services (EMS) are
recovered through user fees. However, the nature of how EMS costs are recovered is
unique to the healthcare industry. The City has little control over the actual amount of
revenue collected due to adjustments made by various payer sources.
Based on prior fiscal year data, it is estimated that the Newport Beach Fire Department
will have provided Medi -Cal Services to 434 CalOptima plan members in FY 2018-19.
The total cost of providing these services is estimated at $677,908 and the actual
payments received is estimated at $55,658, resulting in unreimbursed costs of $622,250.
Participation in the Medi -Cal Rate Range IGT provides the City an opportunity to recover
up to $321,486 of these unreimbursed costs.
The Medi -Cal Rate Range IGT is implemented through the execution of two (2)
agreements:
(1) An agreement with DHCS regarding the City's transfer of the FY 2018-19 IGT amount
of $268,140 and twenty percent IGT assessment fee of $53,628 (Attachment B);
(2) An agreement with CalOptima regarding the terms upon which the City is paid its
previously unreimbursed costs for providing transport services to Medi -Cal plan
members plus the additional federal funds made available as a result of participation
in the IGT program (Attachment C).
To participate in the IGT program for FY 2018-19, the two agreements attached hereto
must be executed and returned to DHCS by July 31, 2019. While there is no contractual
guarantee of the City receiving all of its initial investment via payments from CalOptima,
it is the City's understanding that all other local governments in the State of California that
have participated in the IGT program in prior years have received all of their initial
investment plus the IGT -funded rate increase. Additionally, our own history with the
program has been successful as shown in the following table:
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Resolution No. 2019-67: Participation in the Medi -Cal Managed Care Rate Range
Intergovernmental Transfer Program to Increase Reimbursement for
Ambulance Transport Services
July 9, 2019
Page 3
Participation
Fiscal Year
Funds
Transferred
Funds
Returned
Revenue
Increase
Approx. Rate
of Return
FY 2014-15
$266,191
$356,554
$90,363
$1.34 per $1
FY 2015-16
$192,616
$290,897
$98,281
$1.51 per $1
FY 2016-17
$267,005
$383,471
$116,466
$1.44 per $1
FY 2017-18
$273,083
$571,081
$297,998
$2.09 per $1
Total
$98,895
$1,602,003
$603,108
* In FY 2017-18, the Federal match rate was expanded to include the Optional Medicaid Expansion
population resulting in a higher rate of return than previous years.
Once the required agreements are in place, the City will receive a funds transfer request
from DHCS. The timeline for the City to receive the original contribution, initial
assessment fee, and the leveraged additional federal funds, is approximately 60 days
from the transfer.
ENVIRONMENTAL REVIEW:
Staff recommends the City Council find this action is not subject to the California
Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) (the activity will not
result in a direct or reasonably foreseeable indirect physical change in the environment)
and 15060(c)(3) (the activity is not a project as defined in Section 15378) of the CEQA
Guidelines, California Code of Regulations, Title 14, Chapter 3, because it has no
potential for resulting in physical change to the environment, directly or indirectly.
NOTICING:
The agenda item has been noticed according to the Brown Act (72 hours in advance of
the meeting at which the City Council considers the item).
ATTACHMENTS:
Attachment A — Resolution No. 2019-67
Attachment B — Intergovernmental Agreement Regarding Transfer of Public Funds with
DHCS
Attachment C — Health Plan -Provider Agreement, Intergovernmental Transfer Rate
Range Program Agreement with CalOptima
Attachment D — Budget Amendment
5-3
ATTACHMENT A
RESOLUTION NO. 2019- 67
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF NEWPORT BEACH, CALIFORNIA, AUTHORIZING
THE MAYOR AND CITY MANAGER, OR DESIGNEES, TO
EXECUTE AGREEMENTS AND AMENDMENTS WITH
THE DEPARTMENT OF HEALTH CARE SERVICES
(DHCS) AND CALOPTIMA TO PARTICIPATE IN THE
FISCAL YEAR 2018-2019 MEDI-CAL RATE RANGE
INTERGOVERNMENTAL TRANSFER (IGT) PROGRAM
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,
WHEREAS, CalOptima is a County Organized Health System ("COHS") created
by the Orange County Board of Supervisors to serve as the local Medi -Cal managed care
plan for Orange County;
WHEREAS, CalOptima contracts with the State of California to administer
additional Medi -Cal revenues to qualified public entities to offset previously unreimbursed
costs for serving Medi -Cal plan members;
WHEREAS, the City of Newport Beach is a public entity that receives payment
from CalOptima for the provision of emergency medical transport services to CalOptima
members on a fee-for-service basis and has unreimbursed costs associated with
providing these services;
WHEREAS, participation in the IGT Program with CalOptima represents an
opportunity to recover previously unreimbursed costs in an effort to reach full cost
recovery for Emergency Medical Services in accordance with City of Newport Beach
Municipal Code Chapter 3.36; and
WHEREAS, the City of Newport Beach has participated in four (4) IGT transactions
with transfers totaling $998,895 to draw down an additional $603,108 in previously
unreimbursed costs.
NOW, THEREFORE, the City Council of the City of Newport Beach resolves as
follows -
M",
Resolution No. 2019 -
Page 2 of 3
Section 1: The City Council does hereby authorize the Mayor, or designee, to
execute (1) an "Intergovernmental Agreement Regarding Transfer of Public Funds" with
DHCS regarding the City's transfer of the FY2018-2019 IGT amount ($268,140) and
twenty percent (20%) IGT assessment fee ($53,628) and (2) a "Health Plan -Provider
Agreement Intergovernmental Transfer Rate Range Program" agreement with CalOptima
regarding the terms upon which the City is paid its previously unreimbursed costs for
providing transport services to Medi -Cal plan members plus the additional federal funds
made available as a result of participation in the IGT program.
Section 2: The City Council does hereby authorize the City Manager, or designee,
to execute any amendments to the above referenced (1) "Intergovernmental Agreement
Regarding Transfer of Public Funds" and (2) "Health Plan -Provider Agreement
Intergovernmental Transfer Rate Range Program" agreement with respect to the term of
the agreements and any additional funds or transfer fees, so long as such amendments
do not extend the term of such agreements beyond five additional years of their respective
termination dates, and any additional funds or transfer fees provided by the City do not
exceed $120,000.
Section 3: The recitals provided in this resolution are true and correct and are
incorporated into the operative part of this resolution.
Section 4: If any section, subsection, sentence, clause or phrase of this resolution
is, for any reason, held to be invalid or unconstitutional, such decision shall not affect the
validity or constitutionality of the remaining portions of this resolution. The City Council
hereby declares that it would have passed this resolution, and each section, subsection,
sentence, clause or phrase hereof, irrespective of the fact that any one or more sections,
subsections, sentences, clauses or phrases be declared invalid or unconstitutional.
Section 5: The City Council finds the adoption of this resolution is not subject to
the California Environmental Quality Act ("CEQA") pursuant to Sections 15060(c)(2) (the
activity will not result in a direct or reasonably foreseeable indirect physical change in the
environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378)
of the CEQA Guidelines, California Code of Regulations, Title 14, Division 6, Chapter 3,
because it has no potential for resulting in physical change to the environment, directly or
indirectly.
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Resolution No. 2019 -
Page 3 of 3
Section G: This resolution shall take effect immediately upon its adoption by the
City Council, and the City Clerk shall certify the vote adopting the resolution.
ADOPTED this 9th day of July, 2019.
Diane B. Dixon
Mayor
ATTEST:
Leilani I. Brown
City Clerk
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Aaron C. Harp
City Attorney
5-6
1
Intergovernmental Agreement Regarding Transfer of Public Funds with DHCS
5-7
CONTRACT #18-95606
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 NEWPORT BEACH, a California
municipal corporation and charter city operating through its Fire Department,
(GOVERNMENTAL FUNDING ENTITY) with respect to the matters set forth below.
The parties agree as follows:
AGREEMENT
1. Transfer of Public 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 funds 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 DHCS.
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
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CONTRACT #18-95606
money excluded from use as State match, impermissible taxes, and non -bona fide provider -
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 funding.
1.3 DHCS shall reconcile the "Estimated Member Months," in Exhibit 1, to
actual enrollment in HEALTH PLAN(S) for the service period of July 1, 2018 through June 30,
2019 using actual enrollment figures taken from DHCS 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 FUNDING ENTITY agrees to transfer any additional
funds necessary to cover the difference. If this reconciliation results in a decrease to the total
amount necessary to fund the nonfederal share of the payments described in Sub -Section 2.2,
DHCS 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 future 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 funds 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 14-301.4(b)(4)
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CONTRACT #18-95606
of the Welfare and Institutions Code as reflected in the contribution PMPM and rate categories
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 1, 2018 through June 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 DHCS will obtain any necessary approvals
from the Centers for Medicare and Medicaid Services.
2.5 DHCS shall not direct HEALTH 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 funds
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 funds transferred pursuant to Section 1 that will not be subject to a
20 percent fee. DHCS has determined that $0.00 of the transfer amounts will not be assessed a
20 percent fee, subject to Sub -Section 3.3.
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CONTRACT #18-95606
3.3 The 20 -percent assessment fee pursuant to this Agreement is non-
refundable and shall be wired to DHCS 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 in 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 made.
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.
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:
Administrative Manager
City of Newport Beach Fire Department
100 Civic Center Drive
Newport Beach, CA 92660
acresniambfd.net
With copies to:
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CONTRACT #18-95606
To DHCS:
City Attorney
City of Newport Beach
100 Civic Center Drive
Newport Beach, CA 92660
smissirligg@,neMortbeachca ggv
Sandra Dixon
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., Suite 71-4002
MS 4413
Sacramento, CA 95814
Sandra.Dixongdhcs. ca. gov
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
subject matter of this Agreement. 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. 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 -enforcement 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.
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CONTRACT #18-95606
6.3 Sections 2 and 3 of this Agreement shall survive the expiration or
termination of this Agreement.
6.4 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.
6.5 Time is of the essence in this Agreement.
6.6 Each 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 DHCS' 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.
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CONTRACT #18-95606
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on
the date of the last signature below.
THE CITY OF NEWPORT BEACH:
.0
Diane B. Dixon, Mayor
Date:
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
Date:
Jennifer Lopez, Division Chief, Capitated Rates Development Division
Attest:
Leilani I. Brown, MMC, City Clerk
Date:
Template Version- 7/2018
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
a+
By:
Aaron C. Harp, rify Attome
7
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CONTRACT #18-95606
Exhibit 1
Funding Entity:
Health Plan:
Rating Region:
City of Newport Beach
CalOptima _
Orange
Rate Category
Contribution PMPM
Estimated Member
Months
Estimated
Contribution (Non
Federal Share)
Child - non MCHIP
$
0.02
2,517,705
$
50,354
Adult - non MCHIP
$
0.06
1,126,289
$
67,577
Adult - MCHIP
$
0.02
40,055
$
801
SPD
$
0.15
482,490
$
72,374
SPD/Full-Dual
$
0.04
26,675
$
1,067
BCCTP
$
0.23
7,396
$
1,701
LTC
$
1.36
14,780
$
20,101
LTC/Fa-Dual
$
0.70
36,930
$
25,851
Optional Expansion
$
0.01
2,831,403
$
28,314
Estimated Total
7,083,723
$
268,140
Template Version- 7/2018
5-15
Health Plan -Provider Agreement
Intergovernmental Transfer Rate Range Program Agreement
5-16
HEALTH PLAN -PROVIDER AGREEMENT
INTERGOVERNMENTAL TRANSFER RATE RANGE PROGRAM AGREEMENT
This Agreement is made this day of , 2019, by and between
CALOPTIMA, a California public agency hereinafter referred to as "PLAN", and the City of
Newport Beach, a California municipal corporation and charter city operating through its Fire
Department, hereinafter referred to as "PROVIDER".
RECITALS:
WHEREAS, PLAN is a public agency formed pursuant to California Welfare and
Institutions Code Section 14087.54 and Orange County Ordinance No. 3896 as amended by
Ordinance Nos. 00-8, 05-008, 06-012, 09-001, 11-013, 14-002 and 16-001, and is party to a
Medi -Cal managed care contract with DHCS, entered into pursuant to Welfare and Institutions
Code Section 14087.3, under which PLAN arranges and pays for the provision of covered Medi -
Cal health care services to eligible Medi -Cal members residing in Orange County;
WHEREAS, PROVIDER is a public healthcare provider of emergency
ambulance transport services, which is a covered Medi -Cal health care service, to persons
enrolled with Medi -Cal Managed Care Health Plan Providers, including PLAN;
WHEREAS, PLAN and PROVIDER desire to enter into this Agreement to
provide for Medi -Cal managed care capitation rate increases to PLAN as a result of
intergovernmental transfers ("IGTs") from City of Newport Beach (GOVERNMENTAL
FUNDING ENTITY) to the California Department of Health Care Services ("State DHCS") to
maintain the availability of Medi -Cal health care services to Medi -Cal beneficiaries.
NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows:
IGT MEDI-CAL MANAGED CARE CAPITATION RATE RANGE INCREASES
1. IGT Capitation Rate Range Increases to PLAN
A. Payment
Should PLAN receive any Medi -Cal managed care capitation rate increases from
State DHCS where the nonfederal share is funded by the GOVERNMENTAL FUNDING
ENTITY specifically pursuant to the provisions of the Intergovernmental Agreement Regarding
Transfer of Public Funds, #18-95606 ("Intergovernmental Agreement") effective for the period
of July 1, 2018 through June 30, 2019 for Intergovernmental Transfer Medi -Cal Managed Care
Rate Range Increases ("IGT MMCRRIs"), PLAN shall pay to' PROVIDER the amount of the
IGT MMCRRIs received from State DHCS, in accordance with paragraph LE below regarding
the form and timing of Local Medi -Cal Managed Care Rate Range ("LMMCRR") IGT
Payments. LMMCRR IGT Payments paid to PROVIDER shall not replace or supplant any other
amounts paid or payable to PROVIDER by PLAN. For purposes of this Agreement, the phrase
5-17
"GOVERNMENTAL FUNDING ENTITY" shall have the same meaning as in the
Intergovernmental Agreement.
B. Health Plan Retention
(1) a. PLAN shall retain 33.32 percent, from the Medi -Cal managed care
rate increases paid to PLAN by DHCS as described in this Agreement prior to disbursing
LMMCRR IGT Payments to PROVIDER. The retained funds will be expended by PLAN for
Covered Services under PLAN's contract with DHCS for Medi -Cal, in either the State fiscal year
received, or in subsequent State fiscal years, as appropriated by the CalOptima Board of
Directors.
Each provider's share of retained amounts shall be calculated based on the provider's
proportionate share of the LMMCRR IGT payment made by PLAN in Orange County.
b. The amounts referenced in this Agreement are estimates. The parties
understand and agree that the total amount of the Medi -Cal managed care capitation rate
increases paid by DHCS to PLAN may fluctuate as a result of enrollment. The parties further
understand and agree that any such fluctuations will likewise affect the amount to be retained by
the PLAN and the amount payable to PROVIDER by the same percentage as the variance in the
capitation rate increases, if any.
(2) PLAN will not retain any other portion of the IGT MMCRRIs received
from the State DHCS other than those mentioned above.
C. Conditions for Receiving Local Medi -Cal Managed Care Rate Range IGT
Payments
As a condition for receiving LMMCRR IGT Payments, PROVIDER shall, as of
the date the particular LMMCRR IGT Payment is due:
(1) continue to provide emergency transport services to PLAN
Members promptly and in a manner which ensures access to care consistent with PROVIDER's
regular business practices for providing such services; and
(2) not discriminate against PLAN Members or in any way impose
limitations on the acceptance of PLAN Members for care or treatment that are not imposed on
other patients of PROVIDER.
WN
D. Schedule and Notice of Transfer of Non -Federal Funds
1. PROVIDER shall provide PLAN with a copy of the schedule regarding the
transfer of funds to State DHCS referred to in the Intergovernmental Transfer Agreement within
fifteen (15) calendar days of establishing such schedule with State DHCS. Additionally,
PROVIDER shall notify PLAN, in writing, no less than seven (7) calendar days prior to any
changes to an existing schedule, including but not limited to, changes to the amounts specified
therein.
2. PROVIDER shall provide PLAN with written notice of the amount and date of
the transfer within seven (7) calendar days after funds have been transferred to State DHCS for
use as the nonfederal share of any IGT MMCRRIs.
E. Form and Timing of Payments
PLAN agrees to pay LMMCRR IGT Payments to PROVIDER in the following
form and according to the following schedule:
(1) PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER using
the same mechanism through which compensation and payments are normally paid to
PROVIDER (e.g., electronic transfer).
(2) PLAN will pay the LMMCRR IGT Payments to PROVIDER no later than
thirty (30) calendar days after receipt of the IGT MMCRRIs from State DHCS.
F. Consideration
(1) As consideration for the LMMCRR IGT Payments, PROVIDER shall use
the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT
Payments in the following manner:
(a) The LMMCRR IGT Payments shall represent compensation for
emergency ambulance services rendered to Medi -Cal PLAN members by PROVIDER between
July 1, 2018, and June 30, 2019, and shall be used by PROVIDER solely to fund the costs that
exceed the fee-for-service rates paid by Medi -Cal PLAN for covered services provided to Medi-
cal PLAN Members during that period.
(b) To the extent that total payments received by PROVIDER for any
State fiscal year under this Agreement exceed the cost of Covered Services provided to Medi -Cal
PLAN members by PROVIDER during that fiscal year, any remaining LMMCRR IGT Payment
amounts shall constitute an overpayment, and shall by returned to Medi -Cal PLAN pursuant to
the provisions of Section 1.K., below
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(2) Both parties agree that none of these funds, either from the
GOVERNMENTAL FUNDING ENTITY or federal matching funds will be recycled back to the
GOVERNMENTAL 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
constitute patient care revenues.
G. PLAN's Oversight Responsibilities
PLAN's oversight responsibilities regarding PROVIDER's use of the LMMCRR
IGT Payments shall be limited as described in this paragraph. PLAN shall request, within thirty
(30) calendar days after the end of each State fiscal year in which LMMCRR IGT Payments
were transferred to PROVIDER, a written confirmation that states whether and how PROVIDER
complied with the provisions set forth in Paragraph 1.F above. In each instance, PROVIDER
shall provide PLAN with written confirmation of compliance within thirty (30) calendar days of
PLAN's request.
H. Cooperation Among Parties
Should disputes or disagreements arise regarding the ultimate computation or
appropriateness of any aspect of the LMMCRR IGT Payments, PROVIDER and PLAN agree to
work together in all respects to support and preserve the LMMCRR IGT Payments to the full
extent possible on behalf of the safety net in Orange County.
I. Reconciliation
Within one hundred twenty (120) calendar days after the end of each of PLAN's
fiscal years in which LMMCRR IGT Payments were made to PROVIDER, PLAN shall perform
a reconciliation of the LMMCRR IGT Payments transmitted to the PROVIDER during the
preceding fiscal year to ensure that the supporting amount of IGT MMCRRIs were received by
PLAN from State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCRR
IGT Payments made in error to PROVIDER within thirty (30) calendar days after receipt from
PLAN of a written notice of the overpayment error, unless PROVIDER submits a written
objection to PLAN. Any such objection shall be resolved in accordance with the dispute
resolution process set forth in Section I.H. The reconciliation processes established under this
paragraph are distinct from the indemnification provisions set forth in Paragraph 1.J below.
PLAN agrees to transmit to the PROVIDER any underpayment of LMMCRR IGT Payments
within thirty (30) calendar days of PLAN's identification of such underpayment.
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J. Indemnification
PROVIDER agrees to and acknowledges the following:
(1) PLAN has no obligation to make any payments hereunder until PLAN has
received IGT MMCRRIs from State DHCS;
(2) that PLAN is not responsible for State DHCS payments to PLAN, including
any mathematical calculations made by DHCS;
(3) PLAN is not responsible for the timing of the payments from DHCS to PLAN
(including the conditions precedent to the timing of such payments which includes the timing of
DHCS submission to CMS and/or CMS review and approval). In addition, PLAN and
PROVIDER agree and acknowledge that nothing herein is intended to create an obligation on the
part of PLAN to agree to delays in capitation payment(s) from State DHCS in order to
accommodate this IGT; and
(4) In the event of any dispute or legal action arising under this Agreement, the
prevailing party shall not be entitled to attorneys' fees.
K. Overpayments and CalOptima Right to Recover
PROVIDER has an obligation to report any overpayment identified by
PROVIDER, and to repay such overpayment to CalOptima within sixty (60) days of such
identification by PROVIDER, or of receipt of notice of an overpayment identified by CalOptima.
PROVIDER acknowledges and agrees that, in the event that CalOptima determines that an
amount has been overpaid or paid in duplicate, or that funds were paid which were not due under
this Contract to PROVIDER, CalOptima shall have the right to recover such amounts from
PROVIDER by recoupment or offset from current or future amounts due from CalOptima to
PROVIDER, after giving notice and an opportunity to return/pay such amounts. This right to
recoupment or offset shall extend to any amounts due from PROVIDER to CalOptima,
including, but not limited to, amounts due because of overpayments as described in the
provisions of this agreement.
2. Term
The term of this Agreement shall commence on July 1, 2018 and shall terminate
on September 30, 2021.
5
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SIGNATURES
HEALTH PLAN: CalOptima
By: Michael Schrader, Chief Executive Officer
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Date: G 1
By:
Aaron C. Harp �� •Lu `�
City Attorney
ATTEST:
Date:
Leilani I. Brown
City Clerk
C,
Date:
CITY OF NEWPORT BEACH,
a California municipal corporation and
charter city operating through its Fire
Department
Date:
Diane B. Dixon
Mayor
5-22
Department: Fire
Requestor: Angela Crespi
City of Newport Beach
BUDGET AMENDMENT
2019-20
ONE TIME: ❑Yes ❑No
ATTACHMENT D
BA#: 002 -CC
Approvals
Prepared by: Susan Giangrapde
❑ CITY MANAGER'S APPROVAL ONLY
Finance Director:
Date
El COUNCIL APPROVAL REQUIRED City Clerk:
Date
EXPLANATION FOR REQUEST:
To increase revenue estimates and expenditure appropriations related to the Medi -Cal IGT program. ❑from existing budget appropriations
❑✓ from additional estimated revenues
❑from unappropriated fund balance
REVENUES
Fund # Org Object Project
010 101040404 431246 1
Description
Emergency Medical Services - Medi -Cal I t
Increase or (Decrease) $
$643,254.00
EXPENDITURES
Fund # Org
Object Project
Subtotal
Description
$643,254.00
Increase or (Decrease) $
010 101040404 821008
Emergency Medical Services - Medi -Cal Igt
$321,768.00
FUND BALANCE
Fund # Object
010 300000
Description
General Fund - Unappropriated Fund Balance
Subtotal
Subtotal
$321,768.00
Increase or Decrease $
$321,486.00
$321,486.00
Fund Balance Change Required
5-23