HomeMy WebLinkAbout08 - Medi-Cal Managed Care Rate Range Intergovernmental Transfer (IGT) Program for Cost Recovery of Emergency Medical Services for Calendar Year 2022Q �EwPpRT
CITY OF
s NEWPORT BEACH
`q44:09 City Council Staff Report
November 14, 2023
Agenda Item No. 8
TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM: Jeff Boyles, Fire Chief - 949-644-3101, jboyles@nbfd.net
PREPARED BY: Raymund Reyes, Administrative Manager, rreyes@nbfd.net
949-644-3352
TITLE: Resolution No. 2023-66: Medi-Cal Managed Care Rate Range
Intergovernmental Transfer (IGT) Program for Cost Recovery of
Emergency Medical Services for Calendar Year 2022
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 seven transactions to secure a total of $1,555,358
in increased net revenue. Continued participation in the IGT allows the City to obtain
additional federal funds to offset previously unreimbursed costs for providing Medi-Cal
plan members with EMS services. Participation in the IGT program is on a year -by -year
basis and is now available for the services provided for the period of January 2022
through December 2022.
RECOMMENDATIONS:
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. 2023-66, 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, 2022 Through
December 31, 2022 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
e) Approve Budget Amendment No. 24-033 appropriating $419,272 in increased
expenditures in Account No. 01040404-821008 (IGT) from the General Fund
unappropriated fund balance and increasing revenue estimates related to the
Medi-Cal IGT Program by $1,017,509 in Account No. 01040404-431246.
8-1
Medi-Cal Managed Care Rate Range Intergovernmental Transfer (IGT) Program for
Cost Recovery of Emergency Medical Services for Calendar Year 2022
November 14, 2023
Page 2
DISCUSSION:
The City's costs of delivering emergency medical services (EMS) are recovered through
user fees established by the City Council. Due to the nature of EMS cost recovery in the
healthcare industry, the City has limited control over the actual amount of revenue
collected. Adjustments made by various payer sources (i.e., insurance plans, including
state and federal insurance programs such as Medi-Cal) mean that the City is not fully
reimbursed for services.
Authorized under the Welfare and Institutions Code Sections 14164 and 14301.4, DHCS
implements a Voluntary Rate Range Program related to Medi-Cal managed care
capitation rate ranges. The funding amounts under this Medi-Cal Managed Care Rate
Range IGT Program consist of the nonfederal share of the difference between the Medi-
Cal managed care plan's contracted rates and the top of the plans' actuarially sound rate
range, as determined by DHCS. The program offers agencies the opportunity to secure
additional Medi-Cal revenues that would normally remain uncollected by leveraging their
nonfederal local funds.
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 the ability to participate in the Medi-Cal Managed Care Rate Range IGT
Program.
The program is voluntary and there is no contractual guarantee of the City receiving its
initial investment. However, other local California governments participating in the IGT
program have previously received their initial investment plus the additional IGT funds
for a net revenue increase. 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 $1
5
FY 2018-19
$285,141
$588,822
$303,681
$2.07 per $1
6
7/2019-12/2020
$534,785
$655,324
$120,539
$1.23 per $1
7
CY 2021
$310,177
$838,207
$528,030
$2.70 per $1
TOTAL
$2,128,998
$3,684,356
$1,555,358
$1.73 per $1
Since the City has participated in the program, more funds have been returned than
transferred. The variation in the amount of funding returned is due to several factors. In
Fiscal Year 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.
8-2
Medi-Cal Managed Care Rate Range Intergovernmental Transfer (IGT) Program for
Cost Recovery of Emergency Medical Services for Calendar Year 2022
November 14, 2023
Page 3
Due to COVID, the FY 2019-20 reporting period was extended to December 31, 2020,
and there was a significant drop in the number of patient transports. CalOptima amended
its agreement for Calendar Year 2021 to reduce its share from 50% to 2%, increasing the
City's share to 98% of net transaction revenue. Participation in the Medi-Cal Rate Range
IGT for the service period of January 2022 through December 2022 provides the City an
opportunity to recover up to $598,237 of unreimbursed costs, as estimated by CalOptima.
A City Council resolution must be adopted to participate in the program, and agreements
with both DHCS and CalOptima must be executed. The agreement with DHCS outlines
the necessary transfer of funds for the service period, including a 20% administrative fee.
The agreement with CalOptima details the terms upon which the City is paid the
unreimbursed costs for providing transport services to Medi-Cal plan members, plus
additional federal funds made available due to participation in the IGT program. Staff
recommends adoption of the resolution and approval of the respective agreements with
DHCS and CalOptima.
If approved and once the required agreements are in place (the signed agreement with
DHCS is due no later than November 24), the City will receive a funds transfer request
from DHCS. DHCS currently estimates that invoicing for agency IGT amounts will take
place in January 2024.
FISCAL IMPACT:
To participate as a funding entity, the City must transfer $419,272 in local funds to DHCS,
which includes a 20% assessment fee of $69,879. DHCS will then use the local funds
provided to draw down additional federal funds and access the highest allowable
Medi-Cal reimbursement rate from the federal government. The City expects to be fully
reimbursed for the initial contribution and the 20% assessment fee, as well as receiving
up to $598,237 in new revenue from the IGT-funded federal match, for a total revenue
increase of $1,017,509.
Prior to distribution of the IGT-funded capitation rate increase to the City, CalOptima will
retain up to $12,209 (2% 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.
The Budget Amendment appropriates $1,017,509 in additional revenue from DHCS,
which is distributed by CalOptima, and $419,272 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 purchase will be expensed to the
Emergency Medical Services — Medi-Cal IGT account in the Fire Department, 01040404-
821008.
8-3
Medi-Cal Managed Care Rate Range Intergovernmental Transfer (IGT) Program for
Cost Recovery of Emergency Medical Services for Calendar Year 2022
November 14, 2023
Page 4
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. 2023-66
Attachment B
— IGT Program Breakdown Estimate
Attachment C
— Agreement with Department of Health Care Services
Attachment D
— Agreement with CalOptima
Attachment E
— Budget Amendment No. 24-033
RM
ATTACHMENT A
RESOLUTION NO. 2023- 66
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, 2022 THROUGH
DECEMBER 31, 2022 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 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 ("City") 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 has participated in seven (7) IGT transactions with transfers
totaling Two Million One Hundred Twenty -Eight Thousand Nine Hundred Ninety -Eight
Dollars and 00/100 ($2,128,998.00) to draw down an additional One Million Five Hundred
Fifty -Five Thousand Three Hundred Fifty -Eight Dollars and 00/100 ($1,555,358.00) in
previously unreimbursed costs.
EM
Resolution No. 2023-
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) the "Intergovernmental Agreement Regarding Transfer of Public Funds" with
DHCS regarding the City's transfer of the IGT amount of Three Hundred Forty -Nine
Thousand Three Hundred Ninety -Three Dollars and 001100 ($349,393.00) and a twenty
percent (20%) IGT assessment fee of Sixty -Nine Thousand Eight Hundred Seventy -Nine
Dollars and 00/100 ($69,879.00) for the rating period from January 1, 2022 through
December 31, 2022, and (2) the "Health Plan -Provider Agreement Intergovernmental
Transfer Rate Range Program Agreement" with CalOptima regarding the terms upon
which the City will be 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 and all amendments to the above referenced agreements with
respect to the terms of the agreements and any additional funds or transfer fees, so long
as such amendments do not extend the terms 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.
Resolution No. 2023-
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 14th day of November, 2023.
NOAH BLOM
Mayor
ATTEST:
Leilani I. Brown
City Clerk
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFI E
06^-- c
Aar6 C. Harp
City Attorney
r;�
ATTACHMENT B
Projections for CY 2022 IGT Transaction with City of Newport Beach Fire Department
CalOptima Health, 10-27-2023
ESTIMATE for City of Newport Beach Fire Department
Amount
1. City of Newport Beach IGT Transfer to DHCS
$
349,393
2. City of Newport Beach Additional 20% State Fee to DHCS
$
69,879
3. Federal Match of City of Newport Beach IGT
$
680,324
4. Increased Capitation Payment from DHCS to CalOptima Health
$
1,029,717
5. City of Newport Beach's Initial Contribution (Original transfer + 20% State Fee)
$
419,272
6. Net IGT Transaction Revenue for Orange County
$
610,446
98% Share for City of Newport Beach
$
598,237
2% Share for CalOptima Health
$
12,209
7. Total Payment to City of Newport Beach
$
1,017,509
Anticipated Rate of Return for City of Newport Beach
243%
ATTACHMENT C CONTRACT # IGT-22-0010
INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES ("DHCS") and 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
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 January 1, 2022, through December 31, 2022 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 # IGT-22-0010
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, 2022, through
December 31, 2022 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, 2022. 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 Intergovernmental Transfer (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
2
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CONTRACT # IGT-22-0010
of Medi-Cal Managed Care actuarially sound capitation rates described in section 14301.4(b)(4)
of the Welfare and Institutions Code as reflected in the contribution PMPM and rate categories
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, 2022, through December 31, 2022, 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 I 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
3
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CONTRACT # IGT-22-0010
20 percent fee. DHCS has determined that $ 0.00 of the transfer amounts, as shown in the table
below, will not be assessed a 20 percent fee, subject to Sub -Section 3.3.
3.3 The 20-percent assessment fee pursuant to this Agreement is non-
refundable and shall be wired to DHCS simultaneously with the transfer amounts made under
Section I 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 either be sent via secure email or submitted in writing 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 as set forth below:
To the GOVERNMENTAL FUNDING ENTITY:
Kristin Thompson, EMS Division Chief
100 Civic Center Drive
Newport Beach, CA 92660
(949) 644-3385
kthompson(aOW.net
4
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CONTRACT # IGT-22-0010
With copies to:
Raymund Reyes, Administrative Manager
100 Civic Center Drive
Newport Beach, CA 92660
(949) 644-3352
rreyesanbfd.net
To DHCS:
Vivian Beeck
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., MS 4413
Sacramento, CA 95814
Vivian.BeeckAdhcs.ca.gov
Any required signature(s) on any documents must be in compliance with California Government
Code section 16.5 and any other applicable state or federal regulations.
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.
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CONTRACT # IGT-22-0010
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.
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 January 1, 2022, and shall expire as
of June 30, 2025 unless terminated earlier by mutual agreement of the parties.
X,
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MW
CONTRACT # IGT-22-0010
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on
the date of the last signature below.
CITY OF NEWPORT BEACH:
Date:
Noah Blom, Mayor
ATTEST
Date:
BY:
Leilani I. Brown, City Clerk
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Date: /0' 3/ 23
By: Y�✓
Aa nY. Harp, ity'A rney
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
Date:
David Bishop, Acting Division Chief, Capitated Rates Development Division
7
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CONTRACT # IGT-22-0010
Exhibit 1
Health Plan
Funding Entity
County
Service Period
Participation %
CalOptima
City of Newport Beach
Orange
1/2022-12/2022
0.70%
Category of Aid
SIS/UIS
Contribution
PMPM
Estimated Member
Months*
Estimated
Contribution (Non -
Federal Share)
Child
SIS
$ 0.02
3,520,004
$ 70,400
Child
UIS
$ 0.03
106,221
$ 3,187
Adult
SIS
$ 0.04
1,312,319
$ 52,493
Adult
UIS
$ 0.15
195,134
$ 29,270
ACA Optional Expansion
SIS
$ 0.01
3,556,781
$ 35,568
ACA Optional Expansion
UIS
$ 0.12
294,319
$ 35,318
SPD
SIS
$ 0.10
435,057
$ 43,506
SPD
UIS
$ 0.32
60,061
$ 19,220
SPD/Full-Dual
SIS
$ 0.03
75,272
$ 2,258
SPD/Full-Dual
UIS
$ 0.09
483
$ 43
LTC (non -dual)
SIS
$ 1.08
11,376
$ 12,286
LTC (non -dual)
UIS
$ 2.24
2,916
$ 6,532
LTC/Full-Dual
SIS
$ -
-
$ -
LTC/Full-Dual
UIS
$ 1.34
87
$ 117
Whole Child Model
SIS
$ 0.27
137,953
$ 37,247
Whole Child Model
UIS
$ 0.54
3,608
$ 1,948
Est. FE Total
9,711,591
$ 349,393
* Note that Estimated Member Months are subject to variation, and the actual total Contribution
(Non -Federal Share) may differ from the amount listed here.
* FMAP is a weighted blend of multiple FMAPs.
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8-16
ATTACHMENT D
HEALTH PLAN -PROVIDER AGREEMENT
INTERGOVERNMENTAL TRANSFER RATE RANGE PROGRAM AGREEMENT
This Agreement is made this I" day of November, 2023, by and between CALOPTIMA
HEALTH, 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, l 1-013, 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 Canitation 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, #22-0010 ("Intergovernmental Agreement") effective for the period of
January 1, 2022 through December 31, 2022 for Intergovernmental Transfer Medi-Cal Managed
Care Rate Range Increases (`IGT MMCRRls"), 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.
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B. Health Plan Retention
(1) a. PLAN shall retain two percent (2.0%) of the net proceeds (after
reimbursing PROVIDER's initial contribution for the transaction), 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 Health 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.
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.
4
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 MMCRRls 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, 2022, and December 31, 2022, 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
(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 LF above. In each instance, PROVIDER
3
8-19
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.
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.
4
8-20
K. Overpayments and CalOptima Health Right to Recover
PROVIDER has an obligation to report any overpayment identified by
PROVIDER, and to repay such overpayment to CalOptima Health within sixty (60) days of such
identification by PROVIDER, or of receipt of notice of an overpayment identified by CalOptima
Health. PROVIDER acknowledges and agrees that, in the event that CalOptima Health
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 Health shall have the right to
recover such amounts from PROVIDER by recoupment or offset from current or future amounts
due from CalOptima Health 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 Health, including, but not limited to, amounts due because of
overpayments as described in the provisions of this agreement.
Term
The term of this Agreement shall commence on January 1, 2022 and shall
terminate on June 30, 2025,
SIGNATURES
HEALTH PLAN: CalOptima Health
Date:
By: Yunkyung Kim, Chief Operating Officer
PROVIDER: City of Newport Beach
Date:
By: Noah Blom, Mayor
ATTEST:
Date:
By: Leilani 1. Brown, City Clerk
APPROVED AS TO FROM:
f ` " Date: / 0 ' 3 /"' Z 3
y: AAron C. H,(p, Cij� A
8-21
City of Newport Beach ATTACHMENT E
x BUDGET AMENDMENT
2023-24 BA#: 24-033
Department: Fire
ONETIME: ❑ Yes ❑ No
Requestor: Raymund Reyes
Approvals
❑ CITY MANAGER'S APPROVAL ONLY
Finance Director: 014gozojoDate 11111x3
❑ COUNCIL APPROVAL REQUIRED City Clerk: Date
EXPLANATION FOR REQUEST:
Accept Medi-Cal IGT Program revenue and appropriate expenditure account. ❑ from misting budget appropriations
❑� from additional estimated revenues
❑ from unappropriated fund balance
REVENUES
Fund #
Org
Object Project
Description
Increase or {Decrease} 5
010
01040404
431246
EMERGENCY MEDICAL SERVICES - MEDI-CAL IGT
1,017,509.00
Subtotal$ 1,017,509.00
EXPENDITURES
Fund #
Org
Object Project
Description
Increase or (Decrease) $
010
01040404
821008
EMERGENCY MEDICAL SERVICES - MEDI-CAL IGT
419,272.00
Subtotal $ 419,272.00
FUND BALANCE
Fund #
Object
Description
Increase or (Decrease) $
010
300000
GENERAL FUND - FUND BALANCE CONTROL
598,237.00
Subtotal I $ 598,237.00
Fund Balance Change Required
8-22