HomeMy WebLinkAbout07 - Medi -Cal Managed Care Rate Range Intergovernmental Transfer (IGT) Program for Cost Recovery of EMS ServicesQ �EwPpRT
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z NEWPORT BEACH
<,FORN'P City Council Staff Report
November 16, 2021
Agenda Item No. 7
TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM: Jeff Boyles, Fire Chief - 949-644-3101, jboyles@nbfd.net
PREPARED BY: Mary Locey, Administrative Division Manager, mlocey@nbfd.net
PHONE: 949-644-3352
TITLE: Resolution No. 2021-110: Medi -Cal Managed Care Rate Range
Intergovernmental Transfer (IGT) Program for Cost Recovery of EMS
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 its local Medi -Cal managed care plan. To date, the City of Newport Beach (City) has
successfully participated in six transactions to secure a total of $1,027,328 in increased
revenue. Continued participation in the IGT allows the City to receive additional Federal
funds to offset previously unreimbursed costs for providing Medi -Cal plan members
emergency medical and transport services. Participation in the IGT program is on a year -
by -year basis and is currently available for the services provided for the period of January
2021 through December 2021.
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. 2021-110, 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 Rating Period of January 1, 2021 through
December 31, 2021 Medi -Cal Rate Range Intergovernmental Transfer (IGT) Program;
c) Authorize the Mayor and City Clerk to execute the Intergovernmental Agreement
Regarding Transfer of Public Funds with the California Department of Health Care
Services;
d) Authorize the Mayor and City Clerk to execute the Health Plan -Provider Agreement
Intergovernmental Transfer Rate Range Program Agreement with CalOptima; and
7-1
Resolution No. 2021-110: Medi -Cal Managed Care Rate Range Intergovernmental
Transfer (IGT) Program for Cost Recovery of EMS Services
November 16, 2021
Page 2
e) Approve Budget Amendment No. 22-021 increasing revenue estimates and
expenditure appropriations related to the Medi -Cal IGT Program. Additional revenues
are estimated to be up to $579,129 in Medi -Cal IGT Program funds (account number
01040404-431246) and increased expenditure appropriations are estimated to be up
to $310,177 in Medi -Cal IGT Program expenditures (account number 01040404-
821008).
DISCUSSION:
The costs associated with the City delivering emergency medical services (EMS) are
recovered through user fees as established by the City Council. However, the nature of
EMS cost recovery 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.
The DHCS IGT program offers the opportunity to secure additional Medi -Cal revenues,
which would normally be uncollected. Authorized under the Welfare and Institutions Code,
Sections 14164 and 14301.4, the DHCS implements a voluntary Rate Range Program
relating to Medi -Cal managed care capitation rate ranges. The funding amounts under
the program are the nonfederal share of the difference between the Medi -Cal managed
care plans' contracted rates and the top of the plans' actuarially sound rate range, as
determined by DHCS.
CalOptima is the County Organized Health System 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 allowed fire departments that provide ambulance transport
services to participate in the Medi -Cal Managed Care Rate Range IGT Program.
Based on data from the 12 -month period of July 1, 2019 through June 30, 2020, it is
estimated that the Newport Beach Fire Department provided Medi -Cal services to 377
CalOptima plan members. The total cost of providing these services is estimated at
$609,654 and the actual payments received are estimated at $114,671, resulting in
unreimbursed costs of $494,983. (See Attachment A, Section 2.)
Participation in the Medi -Cal Rate Range IGT for the period of January 2021 through
December 2021 provides the City an opportunity to recover up to $268,952 of
unreimbursed costs, as estimated by CalOptima.
Rate Range IGT Program Participation
The Rate Range IGT program is voluntary and allows health care providers, such as the
Newport Beach Fire Department, the ability to offset previously unreimbursed costs for
serving Medi -Cal plan members.
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Resolution No. 2021-110: Medi -Cal Managed Care Rate Range Intergovernmental
Transfer (IGT) Program for Cost Recovery of EMS Services
November 16, 2021
Page 3
To participate, a City Council resolution (Attachment B) must be adopted, and the
following two agreements need to be executed:
1) An agreement with DHCS regarding the City's transfer for the IGT service period
of January 1, 2021 through December 31, 2021 in the amount of $258,481 and a
20% IGT assessment fee of $51,696 for a total of $310,177 (Attachment C); and
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 due to participation in
the IGT program (Attachment D).
While there is no contractual guarantee of the City receiving its initial investment, it is
staff's understanding that in prior years other local California governments participating
in the IGT program have received their initial investment plus the additional IGT funds
returned for a net revenue increase. Additionally, the City's history with the program has
been successful as reflected in the table below.
Year
Participation
Dates
City Funds
Transferred
Funds
Returned
Revenue
Increased
Approx. Rate
of Return
1
FY 2014-15
$266,191
$356,554
$90,363
$1.34 per $1
2
FY 2015-16
$192,616
$290,897
$98,281
$1.51 per $1
3
FY 2016-17
$267,005
$383,471
$116,466
$1.44 per $1
4
FY 2017-18
$273,083
$571,081
$297,998
$2.09 per $11
5
FY 2018-19
$285,141
$588,822
$303,681
$2.07 per $1
6
7/2019-12/20202
$534,785
$655,324
$120,539
$1.23 per $13
TOTAL
$1,818,821
$2,846,149
$1,027,328
$1.56 per $1
Once the required agreements are in place (the signed agreement with DHCS is due no
later than December 24), the City will receive a funds transfer request from DHCS. The
timeline for the City to receive the original contribution, 20% assessment fee, and the
leveraged additional federal funds, is approximately 30 days after CalOptima receives
funds from DHCS.
FISCAL IMPACT:
To participate as a funding entity, the City must transfer local funds up to a maximum total
contribution of $258,481 to DHCS through an Intergovernmental Transfer (IGT) along
with a 20% assessment fee of up to $51,696 for administering the IGT (for a total of
$310,177).
Beginning 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.
2 Due to COVID, this fiscal year reporting period was extended to December 31, 2020.
3 Patient transports dropped significantly during the year six reporting period due to COVID. Thus, the
rate of return on the City's transfer of funds was less than expected and less than prior years.
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Resolution No. 2021-110: Medi -Cal Managed Care Rate Range Intergovernmental
Transfer (IGT) Program for Cost Recovery of EMS Services
November 16, 2021
Page 4
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 be fully reimbursed for the contribution and the 20% assessment fee
($310,177), as well as receiving $289,952 in new revenue from the IGT -funded federal
match for a total revenue increase of $597,129.
The Budget Amendment appropriates $597,129 in additional revenue from DHCS, which
is distributed by CalOptima, and $310,177 in increased expenditure appropriations. The
revenue will be posted to the Emergency Medical Services — Medi -Cal IGT account in the
Fire Department, 01040404-431246, and the transfer will be expensed to the Emergency
Medical Services — Medi -Cal IGT account in the Fire Department, 01040404-821008.
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
— IGT Program Analysis
Attachment B
— Resolution No. 2021-110
Attachment C
— Agreement with Department of Health Care Services
Attachment D
— Agreement with CalOptima
Attachment E
— Budget Amendment No. 22-021
7-4
ATTACHMENT A
November 16, 2021 City Council Meeting
Medi -Cal Managed Care Rate Range IGT Program
IGT Estimate for City of Newport Beach Fire Department
Amount
Section 1. Projection for Rating Period July 1, 2019 through June 30, 2020
1. City of Newport Beach IGT Transfer to DHCS
$
258,481
2. City of Newport Beach Additional 20% State Fee to DHCS
$
51,696
3. Federal Match of City of Newport Beach IGT
$
589,600
4. Increased Capitation Payment from DHCS to CalOptima
$
848,081
5. City of Newport Beach's Initial Contribution (Original transfer + 20% State Fee)
$
310,177
6. Net IGT Transaction Revenue for Orange County
$
537,904
50% Share for City of Newport Beach
$
268,952
50% Share for CalOptima
$
268,952
7. Total Payment to City of Newport Beach
$
579,129
Anticipated Rate of Return for City of Newport Beach
187%
NOTE: Updated based on DHCS contracts in Fall 2021
Section 2. CalOptima Member Services Provided from July 1, 2019 through June 30, 2020. Amount
1. Cost of Providing Outpatient Services $ 609,654
2. Payments Received from Health Plan $ 114,671
3. Uncompensated Costs $ 494,983
7-5
ATTACHMENT B
RESOLUTION NO. 2021-110
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
RATING PERIOD OF JANUARY 1, 2021 THROUGH
DECEMBER 31, 2021 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 under a current agreement 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 Newport Beach Municipal
Code Chapter 3.36 (Cost Recovery for User Services); and
WHEREAS, the City of Newport Beach has participated in six (6) IGT transactions
with transfers totaling One Million Eight Hundred Eighteen Thousand Eight Hundred and
Twenty One Dollars and 00/100 ($1,818,821.00) to draw down an additional One Million
Twenty Seven Thousand Three Hundred Twenty Eight Dollars and 00/100
($1,027,328.00) in previously unreimbursed costs.
7-6
Resolution No. 2021 -
Page 2 of 3
NOW, THEREFORE, the City Council of the City of Newport Beach resolves as
follows:
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 rating period from January 1, 2021 through
December 31, 2021 IGT amount of Two Hundred Fifty Eight Thousand Four Hundred
Eighty One Dollars and 00/100 ($258,481.00) and twenty percent (20%) IGT assessment
fee of Fifty One Thousand Six Hundred Ninety Six Dollars and 00/100 ($51,696.00); 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 (5) additional years
of their respective termination dates, and any additional funds or transfer fees provided
by the City do not exceed One Hundred Twenty Thousand Dollars and 00/100
($120,000.00).
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.
7-7
Resolution No. 2021 -
Page 3 of 3
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.
Section 6: 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 1611 day of November, 2021.
Brad Avery
Mayor
ATTEST:
Lellani I. Brown
City Clerk
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
/ 6te, — C. #
Aan C. Harp
City Attorney
7-8
ATTACHMENT C CONTRACT # 21-10182
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
("GOVERNMENTAL FUNDING ENTITY") with respect to the matters set forth below.
The parties agree as follows:
AGREEMENT
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
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 January 1, 2021 through December 31, 2021 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
money excluded from use as State match, impermissible taxes, and non -bona fide provider -
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CONTRACT # 21-10182
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 January 1, 2021 through
December 31, 2021 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 December 31, 2021. If
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 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 14301.4(b)(4)
2
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CONTRACT # 21-10182
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 January 1, 2021 through December 31, 2021, 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.
ki
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CONTRACT # 21-10182
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.
5. 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:
Mary Lacey, Administrative Division Manager
City of Newport Beach Fire Department
100 Civic Center Drive
Newport Beach, CA 92660
mlocey@nbfd.net
With copies to:
0
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CONTRACT # 21-10182
City Attorney's Office
City of Newport Beach
100 Civic Center Drive,
Newport Beach, CA 92660
To DHCS:
Vivian Beeck
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., MS 4413
Sacramento, CA 95814
Vivian. Beeckgdhcs. 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 4 21-10182
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.
Approval. This Agreement is of no force and effect until signed by the parties.
Term. This Agreement shall be effective as of January 1, 2021 and shall expire as
Of June 30, 2024 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 NEWPORT BEACH:
Date:
Brad Avery, Mayor
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APPROVED AS TO FORM:
CITY ATT ;RNEY'SOLFFIE
n C�eity
Attorney 6
7-14
CONTRACT # 21-10182
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
Date:
Rafael Davtian, Division Chief, Capitated Rates Development Division
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CONTRACT # 21-10182
Exhibit 1
Health Plan:
CalOptima
Rating Region:
Orange
Service Period
1/2021-12/2021
Rate Category
Contribution
PMPM
Estimated
Member Months*
Estimated
Contribution (Non -
Federal Share)
Child - non MCI -UP
$
0.02
2,432,076
$
48,642
Child - MCI -UP
$
0.01
1,276,065
$
12,761
Adult - non MCHIP (non -CCI)
$
0.05
1,237,366
$
61,868
Adult - MCI -UP (non -CCI)
$
0.03
31,903
$
957
ACA Optional Expansion
$
0.01
3,297,759
$
32,978
SPD
$
0.11
494,384
$
54,382
SPD/Full-Dual (non -CCI)
$
0.03
24,161
$
725
LTC
$
1.09
17,540
$
19,119
Whole Child Model
$
0.24
112,706
$
27,049
Estimated Total
8,923,960
1 $
258,481
* Note that Estimated Member Months are subject to variation, and the actual total Contribution
(Non -Federal Share) may differ from the amount listed here.
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ATTACHMENT D
HEALTH PLAN -PROVIDER AGREEMENT
INTERGOVERNMENTAL TRANSFER RATE RANGE PROGRAM AGREEMENT
This Agreement is made this 1st day of November, 2021, by and between CALOPTIMA,
a California public agency hereinafter referred to as "PLAN", and 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 the 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 Cavitation 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, #21-
10182, ("Intergovernmental Agreement") effective for the period of January 1, 2021 through December
31, 2021 for Intergovernmental Transfer Medi -Cal Managed Care Rate Range Increases ("IGT
MMCRRIs"), PLAN shall pay to PROVIDER the amount of the IGT MMCRRls 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 "GOVERNMENTAL FUNDING ENTITY" shall have the same
meaning as in the Intergovernmental Agreement.
B. Health Plan Retention
(1) a. PLAN shall retain 31.71 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.
City of Newport Beach_IGT Funder Agreement_IGT I I _CI 1342133AA
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Each provider's share of the retained funds 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.
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 January 1,
2021, and December 31, 2021, 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.
City of Newport Beach_IGT Funder Agreement_I I _10004630AA
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(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
l.K., below
(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 IJ 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.
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
City of Newport Beach IGT Funder Agreement_I I _10004630AA
7-19
(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 Riaht 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 January 1, 2021 and shall terminate on
June 30, 2024.
SIGNATi)RF S
HEALTH PLAN: CalOptima
PROVIDER: City of Newport Beach
By: Brad Avery, Mayor
ATTEST:
Leilani 1. Brown, City Clerk
APPROVED AS TO FORM.
C.
Date:
Date:
Date:
Date: (
City of Newport Beach—IGT Funder Agreement_l 1 _] 0004630AA
7-20
Po' T
y1 l' City of Newport Beach
r
� BUDGET AMENDMENT
2021-22
Department: Fire
ONETIME: PlYes [::.No
Requestor: Mary Locey
❑ CITY MANAGER'S APPROVAL ONLY
Finance Director•
D COUNCIL APPROVAL REQUIRED City Clerk:
ATTACHMENT E
BA#: 22-021
Approvals
-� Date Q/ m
Date
EXPLANATION FOR REQUEST:
To increase revenue estimates and expenditure appropriations related to the Medi -Cal Intergovernmental Transfer (IGT) ❑ from existing budget appropriations
Program. ❑✓ from additional estimated revenues
Q from unappropriated fund balance
Federal funds received are used to offset previously unreimbursed costs for providing Medi -Cal plan members
emergency medical and transport services.
REVENUES
Fund #
Org
Object
Project Description
Increase or (Decrease) $
010
01040404
431246
EMERGENCY MEDICAL SERVICES - MEDI-CAL IGT
579,129.00
Subtotal $ 579,129.00
EXPENDITURES
Fund #
Org
Object
Project Description
Increase or (Decrease) $
010
01040404
821008
EMERGENCY MEDICAL SERVICES - MEDI-CAL IGT
310,177.00
Subtotal; $ 310,177.00
-
FUND BALANCE
Fund #
Object
Description
Increase or (Decrease) $
010
300000
GENERAL FUND
- FUND BALANCE CONTROL
268,952.00
Subtotal $ 268,952.00
Fund Balance Change Required
7-21