HomeMy WebLinkAbout08 - Medi-Cal Managed Care Rate Range Intergovernmental Transfer (IGT) ProgramPORT CITY OF
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NEWPORT BEACH
cgt'Pop" City Council Staff Report
June 14, 2016
Agenda Item No. 8
TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM: Scott L. Poster, Fire Chief - 949-644-3101, sposter@nbfd.net
PREPARED BY: Angela S. Crespi, Administrative Manager, acrespi(@-nbfd.net
PHONE: 949-644-3352
TITLE: Medi -Cal Managed Care Rate Range Intergovernmental Transfer
(IGT) Program
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 will allow Fire Departments that provide
ambulance transport services to participate in the Medi -Cal Managed Care Rate Range IGT
for FY2014-2015. Participation in the FY2014-2015 IGT will allow the City to draw down
additional Federal funds to offset previously unreimbursed costs for providing transport
services to Medi -Cal plan members during that fiscal year. Participation in the IGT program is
on a year -by -year basis.
RECOMMENDATION:
a) Determine that the 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 it will
not result in a physical change to the environment, directly or indirectly;
b) Adopt Resolution No. 2016-76, A Resolution of the City Council of the City of Newport
Beach, California, Authorizing the City Manager, or ,Designee, to Execute Agreements
with the Department of Health Care Services (DHCS) and CalOptima to Participate in the
FY 2014-2015 Medi -Cal Managed Care Rate Range Intergovernmental Transfer (IGT)
Program; and
c) Approve Budget Amendment No. 16BA-043 to increase expenditure appropriations by
$308,504.40 in the Medi -Cal IGT account 01040404-821008 and to increase revenue
estimates by $411,339 in the Medi -Cal IGT account 01040404-431246 of the Fire
Department.
8-1
Medi -Cal Managed Care Rate Range Intergovernmental Transfer
June 14, 2016
Page 2
FUNDING REQUIREMENTS:
To participate as a funding entity, the City must transfer local funds up to a maximum total
amount of $257,087 to DHCS through an Intergovernmental Transfer along with a twenty
percent assessment fee of $51,417.40 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 from CalOptima 100 percent of the originally wired funds, including the
twenty percent assessment fee, as well as $102,835 of new revenue from the IGT -funded
rate increase.
The Budget Amendment records and appropriates $411,339 in additional revenue from the
California Department of Healthcare Services distributed by CalOptima and $308,504.40 in
increased expenditure appropriations. The revenue will be posted to the Medi -Cal IGT
account in the Fire Department, 01040404-431246, and the funds transfer will be expensed
to the Medi -Cal IGT account in the Fire Department, 01040404-821008.
DISCUSSION:
The City's costs associated with delivering Emergency Medical Services (EMS) are
recovered through adopted 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. In FY 2014-2015, the
Newport Beach Fire Department provided Medi -Cal Services to 390 CalOptima plan
members. The total cost of providing these services was $564,330 and the actual payments
received were $50,157, resulting in unreimbursed costs of $514,173. Participation in the
Medi -Cal Rate Range IGT provides the City an opportunity to recover some of these
previously unreimbursed costs (up to $102,835.00).
The Medi -Cal Rate Range IGT is implemented through the execution of three (3) separate
agreements:
(1) An agreement with DHCS regarding the City's transfer of the FY2014-2015 IGT amount
of $257,087.00 (Attachment C);
(2) An agreement with DHCS regarding the City's payment of a twenty percent IGT
assessment fee of $51,417.40 for administering the City's participation in the IGT
program for FY2014-2015 (Attachment D); and
(3) 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 E).
To participate in the IGT program for FY2014-2015, the three agreements attached hereto
must be executed and returned to DHCS by June 24, 2016. 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
M
Medi -Cal Managed Care Rate Range Intergovernmental Transfer
June 14, 2016
Page 3
participated in the IGT program in prior years have received all of their initial investment plus
the IGT -funded rate increase.
Once the required agreements are in place, the City will receive a funds transfer request from
DHCS in early September 2016. 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.
Prior to distribution of the IGT -funded capitation rate increase to the City, CalOptima will pay
any Medi -Cal Managed Care Seller's (MMCS) tax due pursuant to the Revenue and Taxation
Code Section 6175 and retain up to $102,835 (50% of the net revenue) for community health
investments in Orange County. CalOptima is the only Medi -Cal managed care plan in the
state approved to retain IGT funds. Such funds have been reinvested in the community to
support programs such as recuperative care for the homeless, service expansions at
community health centers, and care coordinators for CalOptima's vulnerable senior
members.
Locally, CalOptima has completed four IGT transactions to date with UCI, which has brought
over $64 million in additional revenue to Orange County. In addition to the City of Newport
Beach, the City of Orange is also planning to participate in the FY 2014-2015 IGT. Other
public agencies including County of Marin; City of Fresno; City of Sacramento; City of San
Rafael; City of Rialto; and Novato Fire Protection District have all successfully participated in
the Medi -Cal Rate Range IGT program.
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. 2016-76
Attachment B — Budget Amendment No. 16BA-043
Attachment C — Intergovernmental Agreement Regarding Transfer of Public Funds with
DHCS
Attachment D — Intergovernmental Transfer Assessment Fee Agreement with DHCS
Attachment E — Health Plan -Provider Intergovernmental Transfer Rate Range Program
Agreement with CalOptima
RN
ATTACHMENT A
RESOLUTION NO. 2016—
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF NEWPORT BEACH, CALIFORNIA AUTHORIZING THE
CITY MANAGER, OR DESIGNEE, TO EXECUTE
AGREEMENTS WITH THE DEPARTMENT OF HEALTH
CARE SERVICES (DHCS) AND CALOPTIMA TO
PARTICIPATE IN THE FY 2014-2015 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; and
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; and
WHEREAS, CalOptima contracts with the State to administer additional Medi -
Cal revenues to qualified public entities to offset previously unreimbursed costs for
serving Medi -Cal plan members; and
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; and
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.
NOW THEREFORE, the City Council of the City of Newport Beach hereby
resolves as follows:
Section 1: The recitals provided above are true and correct and are
incorporated into the operative part of this resolution.
Section 2: The City Council does hereby authorize the City Manager, or
designee, to execute (1) an "Intergovernmental Agreement Regarding Transfer of Public
Resolution No. 2016 -
Page 2 of 2
Funds" with DHCS regarding the City's transfer of the FY2014-2015 IGT amount
($257,087.00); (2) an "Intergovernmental Transfer Assessment Fee Agreement" with
DHCS regarding the City's payment of a twenty percent IGT assessment fee
($51,417.40) for administering the City's participation in the IGT program for FY2014-
2015; and (3) a "Health Plan -Provider Intergovernmental Transfer Rate Range
Program" agreement with CalOptima regarding the terms upon which the City is paid its
previously unreimbursed 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 3: 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, Chapter 3,
because it has no potential for resulting in physical change to the environment, directly
or indirectly.
Section 4: 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 14th day of June, 2016.
/_T491=15
Leilani I. Brown
City Clerk
2
Diane B. Dixon
Mayor
RIM
Attachment B
BL dget Amendment 16E A-043
H., Fol
City of Newp ort Beach
BUDGET ANENEIMENT
2015-16
EFFECT C N BUDGETARY FUND BALANCE:
Inanease RIEIVEIrIue 8slirriatEls
Inanease Exrlenditure Appiraprialioris AND
Tnanslen Buc gel P pproprialionis
sCURCE:
ilrarr e� istirig LUC get arpnorinialions
ilrarr ac C ilional Elslirr alec IIEIVEIrIUEIs
llrorr unlagprapriMElc funs tlalancEI
B)IRLANAMON:
NCI. BA- 1EIBA-0421
AMC U NT: 914'I I,334I
X Inanease in Buc gelaq Ru rid EleilanCIEl
DEIcrea9EI iri Buc gEltaq Fu ric Balance
Na Elflecil on 13ucgEllary Runic Balariae
This Luc get amEmcmenI is nequesled to Klnmice fcm INET falIawirig:
Ta lrsirisller funic s iri the amou ril of 91I108,90z la CIalOKllima, c'I Claurily Organiiae( HElalth SyslElm, lhnaugh an inlencloVEulnmenial
transfer to the CA DEIrlt. of Heal Ih Cam ServicEls to secune Mec i -Cal ne�enuEls via the Mec i -Cal NanagEld Clare Rlale Reinge ICII
plrcignam. Partiairlatiari iri this program will allow fan the c nawi c awn ctll 'I (I�I,fI(19 iri 11eC Emal funds la neimIcu rsEl the Rine EMS div isiori
fan pine�iausly unireimLunsed aasIs forpimising tnarisport sElruiiaes to Nadi-Clal Fllan members.
ACCOUNTING ENTRY:
BUDGEITARY FUND EIALIANCIEI
Funic,
CIL'ecll
DElsanipIion
CHO
11100000
CeriEmal Run( - Funic Balariae
REIVEA UE EISTiINIM TEIS
C Iq
CILjeCli
DEisanipilian
TI 040404
4312146
Nedi-CalIGT
BXFIENDA7I0FIEI,4 PFIROFIRM TAC
NS
Desciniplian
Org Nu and Em
CH OzC1404
Rine ENS
MjEiat Nu ML Em
E121 (108
N/eci-CIalIGT
P mau nil
IDOL it Clnecil
$z V039
MIa,3134
utomatic System Entry.
Signec :
Rin I AAIplimal: Finariae Di r Dale
Signiec:
Pcmim ativeAppamal: City Nana r Dale
Signec :
Cily Caunail P p1praval: Clily OWN Dale
8-7
Intergovernmental Agreement Regaic ing Transfer of Public FL nd9 with C HC`
., R
CONTRACT A 14-9058(
INTERCCVERNMENIIAL AGREEMENT REGARDING
TRANSIIDRI C1111UBLIC 1 UNDS
This A grciciment is entareid inila betaieen the C ALIBORNIA DEF ARITMEN➢ C B IAEA LITH CARE
SERIMICIF S ("DIICIS") anc thla City of Nowport Bciachl, a C alifornia muniaipal aorporalion and atlarter
aity oparating tluloughl its Bire Dcipemenit, ("Cily") with raspciat to tho masters seit forth below.
RECITALS
A. 'Wis Agraciment is mada plursuannl to the authority of Weafarci & Institutions Codes, sciation
114] (4 and 14-M]A.
A.
B. The Orange County Hcialthl Authoriily, a Caaifornia pubhia agcnaN dba Orange Hrevientiian
and Treatment Integratcid Mcidiiaal Assisilance, dba C alOpiima ("Ca:ICpltima") :is a publia agenay formed
pursuant to Ca:Iiforniia Walfare and Institutions C oda Section 14 (117.34 and Oranges County Crdiniance No.
318%, as amended by Ordinanicci Nasi. 00-41, 0`I-008, W-012, 09-•(1(11, 111-0131 and 14-002. CalOfltima is a
party to a Mcidi-•Cal managad aara aonilract wilhl I3HCS, aritered into pursuant to Welfara and Inst:ilutions
Coca sealioni 14081.3, undar whiahl Ca]IOpt:imia arrariacis and pays for thla plriomision of eamarcic Mcidi-•Cal
Health care scinviiaas to aligib:Ia Madi-Cal membans ncisiding in 1Iho County.
TIHFRFFORE,1hla plarlies agrcia as follows:
A G REEMENT
Transfer aflAub:lia Furies
1.1 Mle Cily shlal:I transfar funds to DHC S plunsuant to sciation 14164 and 14301.4 of
the )Me:Ifara and lnstilutionis Cocci, up to a maximum 11alal amount of Two Hundred Bifty Seman Thousand
E:ightN Sauan dolaaais anc no acnts ($2-417,087.0x), to be used so Icily as a portion of the nonifedcinal shlarie of
acituarially sounc Mcic i -C al rr. ariaged aane caplitation rate iriarieases foci CallOptima for 1I11a plen:iad Ju:Iy 1,
2014 thrioughl June 30, 2013 as dciscr:ih cid in section 2.1 below. Thla funds shlala be Uiansfhrnac in
'Ileimpllate Version -9/11/2(113
CCNTRA C 11 #:14••510`186
acaoisdance w:ilhl a mutually agreac uplan sahadule bamiaen the Cisty and DH C S, in aha amicunts specified
thanain.
1.a 'Wa C:hy sheill aertify thlail the fur ds tiiansfaniad qualify foil federal finianaiaa
plartiaipation pursuant to 42 C.F.R. part 4.13 subpart H, anc arie riot der.ivad from impcuimissib la soujaes
suah as recycled Mledicaid paymiarits, fac aral moray axaluded from use as Stata mailah, impenm.issible
taxas, and none -bona fisc a provider -related c cinationis. Aon tranisfarrinig units of glavarnmar.it 1Ihat eira also
diraat servicia providers, impermissible sourcas c a nick inalude patiani caro or othar revenue naceivac hom
programs suah) as Mledieare or Mediaaid to tha extant iihat the program revenue is r.icit obl:igarted to the
Stala as the source ofIfurCir.ig.
2. Aacapllair iae and Use of Transfenied Funds by UHCS
2.1 DHC S shlalll exaraisa :its authority undar secllion 1141(4 of thla Weafeira and
Instituticins Code to acaept funds ilransferrad by the City pursuant to iihis Agreamiart as intergovernmental
transfers ("IC' ls"),1a usa for 1ha pluwplosa sat forth in section 2.2 belovA.
2.2 The func s Iransfarrac by tha City pursuant to lhlis Agraciment sblaal be usad to fund
a portion of the nonfederal share cif inicreeisas in Madi-Cal managad care actueniial]IN sound capitation railas
dascrib ad in paj agiiaphl (4) of subdivision (b) cif sciationi 14 301.4 of tha Wellfara and Ir.istitutionis Coda and
shall be plaid, togethlar withl iha nellated faderial fmianiaial parlieipat:icn, by UHCS to C alCptima as part cif
C eilOplima's eapitalion ratas for tha period July 1, 20141Ihroughl June 30, 2019. The nate increases plaisc
unc cm saction 2.2 shall be usad for payrnenil s ralall ad to Madii-C ail serviacis ranidared la Mac i -C al
beneficiarlas. Mla rasa iinawasas paid undar this section 2.2 shall ba :in addit:icn to, and shat riot rapllace or
suppllaanit, all other amounts paid or playab:la by D1UCS or oilhar Stata agancies to C adCplima.
2.3 IIHCS shall sada fedaral finanaiall partiaaipation fon the rata inierciasicis specified ir.s
sections 2.1 to lhla fIu:111 extar.it parmittac by federal ]law.
r➢emplate Versions -9/:17/2013
2
CONTRACT Al 14-9058(
1.4 '➢ha parties acknowledge the State DIHCIS will obtains any necessary aplpvcivals
fiom 111a Cenilars for Madiaare and Medicaid Serviaas pdor lice the playmenit of any rate iniaiieasa pursuarit
to sciat:ion 2.2.
2.1 '➢hci parties agrea that nionie of these funds, aithar City or federal malahinig funds
will] ba neayaled baaM to tha Cilly's gararal fund, tha Stata, or any abler :intaiimediary organization.
Paw amts mada by tha health plan to proV dors undar the terms of this A graement and 1 haft provider
agream ant aonstitute paticinl aaira rcivanuas.
2.6 Within Ona Hundrad Twanity (120) aalandar days of the emeaulioni of this
Agraemanl, DIHCIS shall advise the Cilly and ClalOplima of tha amaunt oflthe Madii-Cal rnar.iagad aara
aaplitationi rate ir.iareases that UHCS plaid to CallOpltima during the aplplliaable rate Naar inva: v:ing any
fundi ng a ndar the terms of this A graament.
2.1 If any partion of tha funds tranisfdrred by lhle C:ily plursuanil to this Agracimenit is riot
expended kir the specified rarte increases under Section 2.2, D11 C S shall iieturn the unexpended fiends to
tha City.
3. Amiar.idm amts
3.1 No amanidmenit or modif ciaition to this Agiecimert shall be Iir.iding ori e:ithlai plart)
unless miade in writing and exeauilad by bath plartilas.
3.2 11hle parties shlalll niegotilate in good 1 ithl 110 amand this Agraementt as nieaassaryl and
appropriata to implamar.rt tha requaramenits sat forlhl in sciationi 2 of this Agreemant.
4. Notiaes. Any and alll notices naqu:irac, parmittad or desired to be givens haraundar by onie
parry to the oilhar sheill ba in wrilinig and shall ba de:livared la the other party plerscinailly or bN Unidad
Stales first class, aartified or reg:istarad mail with postaga prepaid, aiddrassed to the other plar N at the
address set forth) ballaw:
' lempllate Varsioni-5/17/2013
8-11
C OMBRACT #14-9098(
To thea City:
C pity of Newp art Beacahl Aire Depart munt
Atiln: Kristin Thompson, EMS B ivis:ican Chief
1(10 C i vie C enter Drime
Navwplort E eaaah, C alifornia 92( ((1
k Ith lompson@nevwportbeac ahcia. gcav
With acapieas to:
To DHCS:
City of Neawport Beaachl
A ttn: Aaran Harp, City Atl ornay
100 Civuia Centar Driva
Newport Beach, California 512660
aharpC nuwportbaachlca.glcav
Sandra Dixon
C alifornaia 17aparlment of Hua:hlh Care Sarvicaes
C aplitalud Matas Ileavealoplmenat Il ivislan
1901 C apitol Ave., Suila 71-4002
MS 44:13
Saaramantca, CA 95514
9. Clhlar Arovisians
5.1 This Agreamiurt caontains thu enthu Agicemanl betvweean the partias with ruspuct to
lhle Medi-Ca;l rata inaruaseas for CalCptima described in suction 2.2 that ane funded by the C ity and
supersedes any plreavious ar contemporianaaus oral or vwritilan proposals, statements, discussions,
nagotiations or othlar agriaemanls butvwaen lha Cidy and DHC S. This Agreemearatt is not, hovwu-Aer, intendad
to b a tha salla agraament butvwuen lhla pardes or miattars rulatingl to tha funding and administration of tha
Mudi-Cal plragram. Ona or more other agrauments already uxist between the partius reglandin8 suchl other
matters, and othar agreements may ba entarad inl a in lhu futura. This A glreaemannl shal l nat modify 1 hu
terms of any othar agruument betwuen thea pari ies.
Tampllale Vlersiora-511123 4
C OIC IIRACT #14-90581E
`1.2 Me nonicnfbriccment ar other waiver of ariN provisicin ofIthis Agrecmcnt shall riot
be aonstrucd as a coritinuing waiver or as ai waivcr ofIany cithleri provision of ihlis Agnccmenit.
A graemani .
Secticin 2 of Ihit Agrc cment shall survive thle exipitafcin ar tcrmiiriat:ioni cif Ithis
5.4 Nothing in this Agiieemcni 's ir.itenided to acinfLir any of ghIs cm iiemc dlcis on any Whid
f arty, including, without ]limitations, any providar(s) on groups of prov:idars, oii any right to medical
scmviaes foci any individual(s) ars €Iroups of �ndivi&als; accordingly, thera shall ba no ihiiid party
bariefrciary of this A gracimenit.
3.5 Time :i s of I thle asseniaa ini this A graemani .
5.6 Eaahl party IIcreby rcprc senits ihlat the pcjisoni(s; emeauti rig thi;is Agreemani on �t9
behalf :is duly authiorizac to c o so.
E. Statci Authcmity. Exccipt as x4pratsly provIdcc Herein, nothing in this Agreamicirit shlalll be
aonstruc d to limas, re striat, or micidify thle DE C S' f ovens, authlorit:icis, and c uiIies under ft daral and siatc
lava and iiagulations.
7. Approval. 11his Agriecimierit is ciflrio forca and cffbct Lniil s:ignad by thia particis.
fl. Teim. Mis Agracment shlalll be effeaiive as of Jluly 1, 2014 and shlalll exipirc as of
Jlunci :10, 2(111 unless termInarted ciarl:icni by mutual eigraemcni of tha pari ies.
Tamplata Mersior.i-SIIIIYI1�-I
5
8-13
CONTRACT #14-90586
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of
the last signature below,
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Date: 64116
By:
Aaron C. Harp
City Attorney
ATTEST:
Date:
Leilani I. Brown
City Clerk
CITY OF NEWPORT BEACH,
a California municipal corporation and charter
city
Date:
By:
Dave Kiff
City Manager
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
Date:
Jennifer Lopez, Acting Division Chief Capitated Rates Development Division
Template Version -5/17/2013
G7
8-14
Intergovernmenllal Transfer Assessment Ree Agreerrierill with DHCSI
CONIIRACT #14-9(1(16
INTERGOMBRNMENTAL TRA NSFERASSESSMENT FEE
This A groamenit is unlaced i d o betwean the CAMBORNIA DBPARTMENII OF HEA LTH CA RFI
SERMICIFIS ("Silatc IMHCS"; and tha City of NaMlort Beach, a Caaifornia munieiplal corparationi and
ahartar city operating thriough ii1s Bira 10aplartmanl, ("City"; wiith raspleci to the miattars sell forth) balow.
RBCI TALS
A. This Agraament is made pursuant to the authlority of Walfane & Inislituticns Code, suction
14301.4.
THEREFORE, the parlies agrau as ftilllows:
A GRBBMBN T
11. 11rar.isfer of Fubllic Funds
1.1 City shall maka Intargovarnmarital Transfari(Is) ("IGTs") to State L MICS pursuant to
suction 141(4 of tha Weafkria and Instiitutionis Code arid paragraph 1.1 of lhla InlargovernmaWoil
ABruemuni(s) Ragardin8 the Tranisfar of Public Bunds aarntract r.iumbar(s) 14-9058(, to be used as a
porticn of thla pion- fadural shara of actuarially sour.ic Mudi-Cal maniagad aare rate ranga eaplitalion
iinareases ("noni-federiall shaja IGT") to Crarniga County Blealth Authority, a California plubllic agenicy dba
Orange F ravanlioni and Treatment Inlegriated Mcidiical Assislanice, dba ClalOpltima ("CalOpllima", for tha
period of July 1, 20141a Jluna 30, 2(11`1.
1.2 The plarticis acknlowacicgp that Sta1a EHCS voila obtain any nieacissary applrova s
from lhla Cantars far Madicara and Medicaid Serviacis ("CMS") parlaining la the acacipltance of nion-
fedaral share IGTs anc the payment oflnior.i-Ridural shlara IC'Il rellatad nate rar.iga eaplitalion iniarciascis to
Cal C Ipti ma.
2. Inlargovanuncintal TranisfLui A ssessmant Fee
Tlemplate Varsion 4,12113
1
FOR
CONTRACT #14-906'1 E
2.1 11hes States IE1HCS shall, upon aaceptanae cif non-feic eiral shlarei IGTIs pursuant ilei the
Inicirgoveirnmentall A greiament(s) Rlegarding the Transfeir of Plubl:ia Bunds, and as clusaribac in paj agraph 11
cif this Agreemant, axeiielse its aulhar:ity under soation 14 301.4 of thla Wellfara and Instituit:ions Coda to
asseiss a M-paraent assessmant faa on 1Ihe antire amount aflthe nan-fadarail shlare IGTs 1ci reIrr.hurse StaiIa
I1HC8 for tho adm:i n1 strative cosi s cif operating the IGII program pursuant 1 o thl:i s seal i on and far the
,support of the Madi-Cal prograrr..
2.2 Thu funds subjeiat to the 20-•peireent assassment fele shlall] be limited to non- faderal
shlarei IGTs m aide by thle transfUrring entity, Clity, pursuant to tela Intenigavarnrr antal Agreameint(s;
Ragarding tha Transfer of PlublIa Bunds, and as c asaribad in paragraph) 1 of this Agreemanl.
2.3 The M-peraent faei will be asisesseid on iIha entirei amounl of iIha noni-fades] sharei
IGIs pursuant to the IntergovernmervIad Agreeirr. ant(s; Rlagarding Iha Transfer cif Bubliia Bunc s, avid as
described in paragraph) 1 of Ihis Agreement, and will] ba mada in aide ition to, avid transferred separately
from, the transfer of flands puirisuant to the llnlargovaiinmenta] A graeimani Is) Rlegarding thle Tlranisifar of
Bub]ia Funds.
2.4 Thu 20-pereani assessment fee pursuant to This Agreiamenit is pion-reifundabla and
shlall] be wirad to elate DHCS seiparately fiiom, and simultaneiouis to, thle nan-fedora] shlare 1 GTs pursuant
to 1Ihe Intargovarnmanlal Agrearrant(s; Regarding lhla "Drair.isfbr of Aublic Bunds, and as dasaribed in
paragraph 1 of this Agreemar.it. Hawevar, if any porticin of the nor.i-f6deiral share IG'Ils is riot axf andac for
thea st eiaifieic rata inareiasas stated in paragraph 2.2 of thle llnleiigovarnmeinitall A graeiment(s) Rlegard:ing the
Transfer cif Bublic Buinds, IE1HCS shall ratuirni a piiopartior.iate amouint cif the 2G.-poraeirit assessmeinl feei to
tha City.
Tlemf]late Varsion 4/2/12 2
8-17
CIONIIRACT #14-90(16
Othar Anavi sions
3.1 This Agneamiar.t aanlainis tha andira Agneemar.it balwaar.i tha part:icis willh nespact to
1Iha 20-pencanil assassment fee an nor.i-Ridanal siharci IC 11s pursuant to thla Intarglavarnmar.ilal Agreamianit(s;
Ragimiding tha Tnansfur of Plublia Bunds, and as dasaribad In paragraph 1, and supersedes any pnavious or
aonitemporanaaus ovall on wjittar.i pnopasails, statements, discussions, nagialliatiians on athan agnciaments
batweeni the lranisfarring enflly and State DIHCIS. Ihies Agreament is not, hlawovan, ;nIlandad to ba ilha sale
agreamiant betwaani tha partias ori masters nalat:ing to lha funding aric administration of thla Medi -Ca]
pnognam. Once an moue oilhcir agreamienits may exist batwaen lhla parries riagard:ing such othlar meittars, and
othlar agneamants may ba anlaned into in the futura. This Agneamanit shlalll not modify thlc terms of any
othan agriciement batwaeni the parties.
12 Aima is of ilha assanice in this Agrournent.
3.3 Each party haraby nepnesants that tha plersori( s) axacut:ing this A graciment on its
behla.lflis duly eiuthlorized to do so.
4. Steite Authlority. Except as axpnassly provided hanain, nothing in this Agreement sheill ba
construed to Errit, restrict, ar modify State DIHCIS' powans, aulhariticis, and duticis undar federiall and state
.law and nagullations.
5. A ppnovall . This A graemant is oil na force arc effcat until signed by the parl i es.
'➢ampleite Vcrosion 4/.2,11.'1
8-18
CONTRACT #14-90616
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of the last
signature below.
City of Newport Beach, a California municipal corporation and charter city Operating through its Fire
Department:
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Date: Vo�/ 6
By: 4 T
Aaron C. Harp
City Attorney
ATTEST:
Date:
an
Leitani 1. Brown
City Clerk
CITY OF NEWPORT BEACH,
a California municipal corporation and charter
city
Date:
By:
Dave Diff
City Manager
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
Date:
Jennifer Lopez, Acting Division Chief, Capitated Dates Development Division
Template Version 4121I2
4
8-19
/_Ti If' • i1 i
HEialilh Plan -F rovic en IntE rgoverrirrienilal Transfen Rale Range Prograrri
A g rE emE nt with CaIC ptima
IIHALMH FIIAN-PRIOMII]BRI
IN"IIHRIGOMERNMENTAIJ TRANSFHRI RATH RANCH FROCRAM AGREEMHNT
TWs A graemanll is mada 11h4 -day of , 201(, by and betvwean
CAIlIOFUMA, a California putIlic agency hlereiimfller rafaned to as "BILIAN", and the City of
Nawport Beaah, ar California muric:ipal aorporationi and ahlartar c:ily operating 11hraughl its Fina
E apartmanl, harciinaftar referred to as " AIROMIDERI".
REC I BALIS:
WIIHRHAS, PLAN is a puibliia agclnay formed pwtuanl to California Walfare and
Inistitullioris Code Section 14087.54 and Orangcl County Ordinancia No. '1896 as amelndad by
Ordinianct Nos. CI(141, 05-CI(Ifl, 06-012, (ISI -0011, 1141113, 114-0(12 and 16-001, and is parry to a
Medi-Ca:l rnar aged care ecintract with E HICK, enrttrac irito pursuant to Walfare and Institutions
Code Station 14081').3, undar whlahl PLAN arrangers ark pays for the provision of aavarcld Mcrc i -
Cal hlclalthl crare sarv:i eras to cilig:i bll a Medi -Call mom t ars rasiding in Orange County,
WIIEREA S, NRIOVIDERI is a publIa hlcialthlcara provider afl emergency ambuilancia
transport samices, whliiah is a coverad Madii-Ca] licialth aare sicirv:iae, to ptnisons enrollac' wiithl
Mad] -Cal Managed C arcs Ilciaaihl Alan Providers, including PLAN;
WHEREAS, PLAN and plDHRI desire to tinier into 11his Agriciament to
provida far Mcici-Cal maniagad aarra aapillationi rata inareases 110 PLAN as a rclsuilt of
inittrgovarrunanlal transfers ("11GTs") from PRIOMME1I to the Calif imiar Departmlanit of Health
Cade 8cuivices ("State DHCSI to maintain tha availability of Meda -Ca] haalth caro serviacrs to
Madi-C all t ancificiasies.
NOW, TIHHRFFORE, PLAN and pIRIOVIIDHRI hlaraby agraci as 16] laws:
IG II MEI] I -CAL MANAGED CARE CAP ITA TIC N RATE RANGE INCREASES
1. IGT Capita tion Rate Ran ga Inicneascimi to PLAN
A. Payment
Should PLAN raclaive any Medii-Cal managed crare mipitation rate :inclraascis fjrom
Stale DIICS vwhaiie lhla nionfederall shalra is funded by thla IlI?JCVIDE14 spacifreally pursuiant to tha
provisions of thle Intergovernmental Agraclmient FJlegarding Traniskiii of Alub:lic Aunds
("Intergovarnmentall A graciment") effealive far the pariod July 11, 2(114 tlulaugh Jluincr SIO, 201f for
11n11argavarnmenitall 1lransftui Medii -Ca] Malriaged Care Mate Mange Inarowicls ("IGT MMCRRIs"),
PLAN slliall pay to PIRIIOMIDHRI the annourit of thla IGT MMCRRIIs reccrivad from Stater DHCS. in
accordanaci withl paragraph LH below regarding the farm and timing of Llocial Medi -Call
Managad Care Bhatti Rllanige ("LIMMCRRP'; ILII Payments. LIMMCRR IGT Playmtnlls paid to
PRIIC MIE E 14 shall I riot replaae or supplant any othler amiounll s pai d or payabll a to AIRIO VID EM by
PIJIAN.
oalOpIima,City oil Newport Beach 51311PA
8-21
B. HcialtH Plan Retention
(11; Mac i -Cal Managac Carle Sciller's Tax
The PLAN shall be rasponisilble foil any Madil•Clal Mana€cid Cara Salllerl's
("MMCS") llax due purisuarrt to tho Rleveniue avid Tawitioni Coda Sact:icini (17'1 ralaliri� to any IGA
MMCRRIs tlulougH June 3Q, 20115. If tha PLAN raceivas any capitaliorl data inaroasas fCir1MMCS
taxas based ori tha JGT MMCRR] s, PLAN may Tial aini an amount equal to tha amount cif sual:l
MMCS tax that ALAN is raqu:irac la pay to tha Stale Board of Equal izal i on, and shall pay, as
parr of the LMMCRR IGA Payments, tha riemiainiinig amount of tha aaflitation riala ir.icniease to
P140MIDE R.
(2) PLAN shall ratair.i 19.:112`15 parcent of the Medi -Cal Managed card rata
ir.iciveases paid la PIAN t y State DIHCS as descriibed ir.i this A € roamenit pri cin to dist ursinlg
LMMCRRI IG➢ Paymanrts to PRIOVIDERI. PIAN and PROVIDIERI eurirent:ly astini that 11.1a
amour.it of such rcita:inac 19.212 -`I -`I peracirit will bei One Iluncrad Two 11housand, Ei�hl Hundred
Tlhlirty-Five Dolllars ($102,8-15), but agriaa arid acknlowlladga that such amount is sulb'aet to
ahlanige dopandiing upon lha final amounts of tha LMMCRRI IC TI Payments as furthleri set l irl h ini
Paras raflh ]LEA A below.
a. Sucihl ratair.iad furies will be fully expended by PLAN to fulfill cina cir more
of tha fol -lowing upon approval by PLAN's Board of Direalors, ini aithler the
Stata fiscal year riecciivad ori subscicluarlt State fiscal yciais:
Community hcialth inivestmants to ilmprova adu:ll mantal health,
ahlildrieni's mantal heallthl, radulae childhood obesity, strenigthlan the
saRity nieil, aridiov :imiprava childrarl's haalth;
ii. Plannir.iE and implamaniting innlovativo prcigramis raquircid uric cni the
Hoalthl Homas Programa and the 111-41 Waivcni :iniltiallives. This
would be a ona-time funding a:lloaat:icin for planning and
implcimentation of pilot pragriam s.
(3) Tho amounts rafdrienecid in this Agreamant ara cistimatas. Tlhle partias
underistanld and agrae that tha total amourit oft thea ] GT MMCR.RIs paid by thle-Stato DHCS tcr-
PLAN may f7uatulata as a riesult of ALAN emiollmar.it. ala parfas furthleri ulnideristand and agnea
that any such flualuationis willl ailklawisa affect the amiciunt to be rcilainied by PLAN and tha
amount playable to PRIOVIIIIERI by the samie flereanlage as 1Iha variance ini capilat:icm iiata
ir.iciveases, if any.
(4) PLAN will r.icit rcilain any cilhciri porticin of thea ICA MMCRRIIs racoivad
frarri the 811 ate I]HICS cilhari thar.l thlosci mciritionled abcivci.
C. Cond itions fcin Rlcicaiiving Loclal M cidf -Cal M an aged Caine Rate Range IC T
P ayments
As a cicinditionl for rocieiving LMMCRRI IGT Payments, PROVIDERI shall, as of
the Cate thle particiullmLMMCRR IGTPaymcinl :is duo:
2
Teimplate Version -1420/12
ClalOpIimadCtly oil Newport Bead 5431/,16
8-22
(1 1) continua to pravi da amerger
plilompltly and in a mannar which ansuras acaasis to
busirlass praatiacls far providing suahl serviaas; and
ay transport serviaas to PLAN Mambars
aare conlsisllanit wilh1 PROVIDIEFJ's ragular
(2) not disariminlata againsl PIIAN Members or i1n any way :impose limillations
on Ifla aaaeptanaa of PLAN Membars fklr aara or trciatmanl thal aria riot impclsed an atllar platients
of PFJOVIDFR.
U. ScIHFIdu le and Nlelticle of Tran skin of Nlon-WidElrlal llun ds,
1. F RIOWDIEM shall promide A IIIAN with a aaply aft the sahac ula regarding the
transfer of funds lla Silate DI -ICS refcirrac to :in Ifla Intargovarnmantal'lransfar Agreemarlt within
fiftaarl (15) clalandar days of aslablishling such sahadule w.i111 Stata DIHCS. Adcitionlally,
ARIOVIDIERI shlala r.Icltify PLAN, in wriiiling, no less than sevlan (1]; callanlcan day priar to any
chlangas to an existing sahledule, including but not himitac lo, changes to the amounts spaaificid
thlarain.
2. PMOMIDHRI shall] provide PLAN willh written notilcle oflilla amiaunt and data ofl
tha tranlsf6ii will in savarl (I7; aalandar daNs afilar funds have baarl transfanlad to State DIHCS far
use as the nanf6daral share ofIany IGT MMCRMIs.
E. &lnm and Timing of I P aym tints
PLAN agilees to paN IJIMMCRRI IGII Payments to PFJOVIEFR in tha fbllawing
farm and according 1 a tha following s ahledula:
(1) ARAN a€Iraas I play tha IIMMCIRM ILII Paymanlls to FFJOVIDIEA using
the same maclllanism 11i11augh whiahl aompenlsationl and payments ane narmally paid to
FFJOVIDIEA (a. g., ell actronia transfer).
(12; FIJIAN will paN the HMMCRFJ IGT Fayments to PROMID1ERdo later than
thirty (:10) calendar days after raceiipl of 1ha IGT MMCRRIs from Stata DIHCS.
F. Considunation
(1) As aonlsidaratian for llha LMMCRR IGT Paymanlls, PRIOVII]FR shall usa
the UMMCRM IGT Payments fbn Ifla 1611lawing plurposas and shall 1lraaf the UMMCRFJ IGT
Paymanits in the fbalclwiing manners:
(1a) Thla IJIMMCRR IGT Paymanlls shlala raprasanl compen,,atlon for
Madi -Cal servicas randarad to Madi-Cal PLAN mambars by PFJC V ID HFJ during i1 ha Sl ata fi sinal
year to which the IIMMC RRI IGT Paymants apply.
Template Version -1/20,112
Calaplima,1CHy o1l Newpor Beach 6131,119
8-23
(b) To tha extant that lotall paymenits recaimad by PRIOVIIDHR fkir any
Slate) fiscal year under thlis Agreamanit exacted the oast of Madi-Cal services pravidad to Medi•
Cal barlefiaianias by FIMOMIDERI during tHat fiscia:l year, any remainling IIMIMCRRI IGT Payment
amounts shlaal be ratainad by FIMOVIIDERI to ba axpandad for health tiara servictes. Ratainad
LIMMCRM IC TI Hayment amount s may ba usad by thle FIMOVIIII BM in eithlar tha 91 ate fi seal yaar
fbr whliah the paymants ara receivad or subsequanit State fiscal yaars.
(2) For purposes cifl subsaction (1) (b) of Paragraph) 1.1 abavia, if lha ratainac
LIMMCRRI IC TI Hayrrents, iflany, are not used by FIMOMIDHRI in isle Slates fiscal year raaeiviad,
ratenticin oft func s t y PRIOVIEHR will t a establlishad by demonstrating thlat thle ratainad earnings
awaunt of FIROMIDIERI at tha uric' aft any Stale $scall yaar int whliahl it reaaived paymanits basad
cin LIMMCRRI ICTI Paymierits funded pursuant to tha Inlargovarnmartaa Agreemant, has
increased ovar the unspant portion of the pricer 81 ate fiscial yaar's ta11anica by the amount of
LMMCRR IGH Haymenits reaaived, but nal usad. Thlasa retained 111140 IIDERI funds may be
comm:ingllad with othlar City oflNewpcirl Beaah, operating through) i1s Fira Dapartmenit, funds fbr
cash) managamenit purposas promided that suahl funds arra appropriataly tracked and only the
depositing ftici:lity is authorized to axpand them.
(21; Both partias agree thlall nonle of Lhasa fiunlds, aithar from the City of
Newport Beaahl, aparat:ing through) its Fire Ilapartmani, or f6daral matcihling fluids will be
ruayaled back) to the Ci11y of Nawport Baachl, operating thilough its Fire Departrrenit, ganeraa
funld, the 91ate, or any other initartradiary orgarlizaiiorl. Payrranits mada by 11ha Health p1lan1 to
providers under thla 1larms of this Agrearnanit aor.1s11tuto pat:iarlt dare ravarluas.
G. P LAN's C nIsight Rlesponsiblillities
FILAN's ovars:ight rasponlsibiliiies regarding HROUIDIEPTs use of the LIMMCRRI
IGTI Payments shlalll be ]limillad as described in thlis paragraph. PLAN shall raquast, within thirty
(3CI; calendar days aftar the enld oil aaahl 811ata fiscall year in whl:iah LMMICRR IUB Payments
ware transferred to PROUIDIERI, a wnitllan aanflrmationl lrlat states whathleri and flaws IHMOMIDIERI
compaiad wi11h the promisionls sat forth) in Paragraph IT aboua. In aachl insllanae, FIRIOVIIDBRI
shall provlida PLAN w1i11h wrilltenl canfirmation of ciarrplianca wiithlin thivy 121(1) cialandar cays of
PIIAN's request.
H. C cloperaticini A mune Ilat 11 ies
Shaul d di sputas or disagiieemarlts arisa regarding the uil l imai a computal ion or
appropriateness ofl any aspect oflthle LIMMCRRI IGT Payments, PRIOVIII7HRI and HLIAN agiiee to
woiRl togathleri int ala respecils to support and preiseirva 11ha LIMMCRRI IGT Haymenits to 11ha flit))
axtenll possibla ori behlallfl of 11 ha safety rat in Orange County.
1 Recicineilliation
II
Ternipla a %vision• 1/20J' 2
CalOplima,01y o1 NEIWF or Heath 5/91116
8-24
Within cinci hundrled twenty l J,]O) calendar days aftcir the end of each cif PLAN's
f:i scal years in which I MMC RRI IG T Paymcnll s wera m ade 1 o HROVIEIE14, PLA N shall parform
a reiconici:liaticin of thea I]MMCRRI IGT Payments transm:illted to tha PROVIEIFR during thea
preciadinig fisaal yciar to ensurci that thea supplort.ing amount of IGT MMCRR]s were reci aived by
PLAN frcam Stata MCS. PRIOVIIEHR agrecas to rellurn to PLAN any overpaymant of IIMMCRM
IGT Payments made in carror to PROMIDER within thirty (21Q aalenidar days after reacaipt from
PLAN of a wlittcin noticie of the overpaymanl eanior, unless PROMIDER submits a wnitleni
cabjactiian to ALAN. Any such objection shall tea rasolvad in acecandanea with the displula
reaso:luliori proacass sell fbrth ini ')action 1.1H. The reacinail:iationi plrccasses asilablishled undan this
paragraph) arc disllinat from tela indcamrificaiion provisions set farlh in Aaaagraphl Ul below.
PLAN agrecas to transmit tca the 11ROVIDIEM any unadarpayment of IMMCRM IGT Paymanlls
within 1lhirty (210) cialcandan days of PLAN's identification of such undcarpayrranit.
J. Indflminliiication
PROVIIE]EM agrecas tca and acknowledges thla fcallowiind: (1) MAN alas nca
obligation 11ca makle arty payments hareaur.idar unt:ill ALAN has ncaciaived IGT MMCRRIs frcam Slaw
E1HCS; (2) that PLAN is not reasponsiblca fo11 Statea EIHCS playmcanats to ALAN, including any
mEithematical calculations made ty I]HCH, and (�-I) PLAN is riot respor.is:iblla for thea t:imirig of thea
paymianits from E1HCS to PLAN (inciluding the coniditicins plraccidanl to the timim8 ofl such
payments whicatl inc.ludas thea timir.ig of I]HCS submission to CMS and/cir CMS ruview and
apprcaval). In additicin, PLAN arid IIROMIIDIER aareae and acknlowledge that r.icilhir.ig hereir.i is
intended tca creala an obligation oni thea part (if IPLAN 11c agree to acilays in eapitalior.i playment(s)
&carni Statca EHICSI in order to acicommodata 11his IGT.
2. Term
MIci term cif 11his Agreemani shall commeaniae on Jully 1, 2014 and shlalll terminate
or Saptemt ear 30, 2(117.
Terriplatei Vousion-1,120,112
ISIGNATURDS ON FOLLOWING PAGE]
Ca10plima4City ofl Newpor Beach 5131,116
8-25
SIGNATURES
CalOptima:
By: Michael Schrader, Chief Executive Officer
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Date: � /6
By: - 1�
Aaron C. Harp
City Attorney
ATTEST:
Date:
By:
Leilani 1. Brown
City Clerk
6
Template Version -1!20112
Date:
CITY OF NEWPORT BEACH,
a California municipal corporation and
charter city operating through its Fire
Department
Date:
Dave Diff
City Manager
CalOptima/City of Newport Beach 5131116
.: 01