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HomeMy WebLinkAboutC-5635-3 - Public Provider Intergovernmental Transfer Program for Ground Emergency Medical Transportation (GEMT) Services Certification Form for State Calendar Year 2025DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES CERTIFICATION FORM FOR STATE CALENDAR YEAR 2025 I, the undersigned, hereby declare and certify on behalf of the City of Newport Beach (the "Public Entity") as follows: 1. As a public administrator, a public officer, or other public individual, I am duly authorized to make this certification. 2. The Public Entity elects to make this intergovernmental transfer (IGT) to the Department of Health Care Service (DHCS) as a voluntary contribution to the non-federal share of Medi-Cal expenditures for purposes of Assembly Bill 1705 (2019) pursuant to Sections 14105.94, 14105.945, 14129, 14129.3, and 14164 of the Welfare and Institutions (W&I) Code. All funds transferred pursuant to this certification qualify for federal financial participation (FFP) pursuant to Section 1903(w) of the Social Security Act and Title 42 of the Code of Federal Regulations, Section 433 Subpart B, and are not derived from impermissible sources such as recycled Medicaid payments, federal money excluded from use as the non-federal share (NFS), impermissible health care -related taxes, or non -bona fide provider - related donations. 3. Voluntary contributions attributable to the period of January 1, 2023, through December 31, 2025, will be made via recurring transfers as indicated on the invoices provided to the Public Entity by DHCS. The voluntary contributions made by the Public Entity may also include adjustments related to the CY 2023 and CY 2024 rating period's NFS reconciliation as described in paragraph 7 below. Please note, the total IGT amount at the bottom of this IGT certification will continue to be itemized on your invoice which is sent to you along with this IGT certification form 45-days in advance of the IGT contribution due date. The Public Entity acknowl- edges that any transfers made pursuant to this certification during this time period are considered an elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to be used by DHCS, subject to paragraph four herein, exclusively as the source for the NFS of ground emergency medical transport public provider supplemental payments in both Medi-Cal fee -for -service payments and the portion of the risk -based capitation rate to Medi-Cal managed care health plans associated with reimbursement made in accordance with Section 14105.945, subdivision (h)(1) (hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Transportation (GEMT) Program, or the PP-GEMT Program), and DHCS costs as- sociated with administering the PP-GEMT Program. 4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP for the PP-GEMT Program as permitted by federal law. In the event DHCS is unable to obtain FFP for the PP-GEMT Program, or the full payments cannot otherwise be made to and retained by eligible public providers, and, therefore, all or a portion of the transferred amount cannot be used as the NFS of payments, DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES CERTIFICATION FORM FOR STATE CALENDAR YEAR 2025 DHCS will notify the Public Entity via e-mail and return the applicable portion of the unused IGT amount. 5. The Public Entity acknowledges that state law in W&I Code section 14105.945, subdivision (h)(2) authorizes DHCS, upon obtaining any necessary approvals, to assess a ten percent (10%) fee on each transfer of public funds to the state to pay for health care coverage and to reimburse DHCS its costs associated with admin- istering the PP-GEMT Program. The Public Entity acknowledges that while DHCS is not assessing this fee currently pending federal approval, DHCS has not waived its right to assess the administrative fee under state law upon obtaining any nec- essary federal approvals. 6. The Public Entity acknowledges that the IGT is to be used by DHCS for the filing of a claim with the federal government for federal funds and understands that any misrepresentation regarding the IGT may violate federal and state law. 7. The amount voluntarily transferred to DHCS is based on the estimated Medi-Cal fee -for -service and Medi-Cal managed care non-federal share of ground emer- gency medical transport payments, as referenced in paragraph three herein. Be- cause the amount to be voluntarily transferred to DHCS will be based on an esti- mate, the Public Entity acknowledges that a reconciliation of the voluntary NFS contributions to the actual NFS expenditures will occur. To the degree necessary to fund the NFS for the PP-GEMT Program, amounts due to or owed by Public Entity as a result of the reconciliation may be offset against, or added to, future transfers as applicable and as determined by DHCS. DHCS may accept a volun- tary contribution to the extent it is able to obtain FFP for PP-GEMT payments as permitted by federal law. 8. The Public Entity acknowledges that all records of funds transferred are subject to review and audit upon DHCS' request. The Public Entity will maintain documentation supporting the allowable funding source of the IGTs. 9. Upon notice from the federal government of a disallowance or deferral related to this IGT, the Public Entity responsible for this IGT shall be the entity responsible for the federal portion of that expenditure. I hereby declare under penalty of perjury under the law of the United States that the foregoing is true and correct to the best of my knowledge. I further understand that the known filing of a false or fraudulent claim, or making false statements in support of a claim, may violate the Federal False Claims Act or other applicable statute and federal law and may be punishable thereunder. DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES CERTIFICATION FORM FOR STATE CALENDAR YEAR 2025 Executed on this Jr-1c day of Signature of Authorized Person: Name of Authorized Person: Grace K. Leung Title of Authorized Person: City Manager Name of Public Entity: City of Newport Beach NPI of Public Entity: 1679579296 Amount of IGT: $83,085.72 2025 atCalifornia. A APPROVED AS TO FORM: CITY AITORNEY'S OFFICE Date: LlILIZ, By: AJ �.� ran C. Harp, City Attorney ,Af Attest: Leilani I. Brow , MMC, City Clerk Date: It \OpoON C WA C� &HCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM MANAGED CARE AND FEE FOR SERVICE - INVOICE Entity information: Due D. 4/18/2025 Entity Name: City Of Newport Beach Payment Details: Year: 2025 Contribution #: 2 NPI: 1679579296 Total Amount Due: $83,085.72 Program/Payee Information: Banking Information: Vendor Name: Bank Name: California Department of Health Care Services US Bank Please await Wire Request Memo for payment instructions PP-GEMT Program Email: Payment Methods Accepted: AB1705@dhcs.ca.aov JACH or Wire Transfer Payment Instructions: Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification form by April 4, 2025, to AB1705@dhcs.ca.gov. IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions. Please do not send your IGT payment until you hove received the Wire Request Memo as payment details are subject to change. DeliveryIGT Non -Federal Share (NFS) Breakdown By DHCS Managed Care (MC) MC NFS #2 $71,936.09 MC Admin Fee #2 $0.00 Fee For Service (FFS) FFS NFS #2 $11,149.63 FFS Admin Fee #2 $0.00 Total* IGT Transfer Amount: $83,085.72 *Any differences are due to rounding. CY 2025 Invoice #1 Invoice Packets Sent 12/3/2024 IGT Certifications Due 1/3/2025 Payment Due 1/17/2025 CY 2025 Invoice #2 Invoice Packets Sent 3/4/2025 IGT Certifications Due 4/4/2025 Payment Due 4/19/2025 CY 2025 Invoice #3 Invoice Packets Sent 6/3/2025 IGT Certifications Due 7/4/2025 Payment Due 7/18/2025 CY 2023 FFS Recon #1 Date of Service Jan - Jun 2023 CY 2024 MC Recon #1 Date of Service Jan - Jun 2024 CY 2025 Invoice #4 Invoice Packets Sent 9/2/2025 IGT Certifications Due 10/3/2025 Payment Due 10/17/2025 CY 2023 FFS Recon #2 Date of Service Jul - Dec 2023 CY 2024 MC Recon #2 Date of Service Jul - Dec 2024 *Schedule subject to change DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES CERTIFICATION FORM FOR STATE CALENDAR YEAR 2025 I, the undersigned, hereby declare and certify on behalf of the City of Newport Beach (the "Public Entity") as follows: 1. As a public administrator, a public officer, or other public individual, I am duly authorized to make this certification. 2. The Public Entity elects to make this intergovernmental transfer (IGT) to the Department of Health Care Service (DHCS) as a voluntary contribution to the non-federal share (NFS) of Medi-Cal expenditures for purposes of Assembly Bill 1705 (2019) pursuant to Sections 14105.94, 14105.945, 14129, 14129.3, and 14164 of the Welfare and Institutions (W&I) Code. All funds transferred pursuant to this certification qualify for federal financial participation (FFP) pursuant to Section 1903(w) of the Social Security Act and Title 42 of the Code of Federal Regulations, Section 433 Subpart B, and are not derived from impermissible sources such as recycled Medicaid payments, federal money excluded from use as the NFS, impermissible health care -related taxes, or non -bona fide provider - related donations. 3. Voluntary contributions attributable to the period of January 1, 2025, through December 31, 2025, will be made via recurring transfers as indicated on the invoices provided to the Public Entity by DHCS. The voluntary contributions made by the Public Entity may also include fee -for -service (FFS) adjustments related to the calendar year (CY) 2023 and managed care (MC) adjustments related to the CY 2024 rating period's NFS reconciliation as described in paragraph seven below. Please note, the total IGT amount at the bottom of this IGT certification will continue to be itemized on your invoice which is sent to you along with this IGT certification form 45-days in advance of the IGT contribution due date. The Public Entity acknowledges that any transfers made pursuant to this certification during this time period are considered an elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to be used by DHCS, subject to paragraph four herein, exclusively as the source for the NFS of ground emergency medical transport public provider supplemental payments in both Medi-Cal FFS payments and the portion of the risk -based capitation rate to Medi- Cal managed care health plans associated with reimbursement made in accordance with Section 14105.945, subdivision (h)(1) (hereafter, the AB 1705 Public Provider Ground Emergency Medical Transportation (PP-GEMT) Program or PP-GEMT Program), and DHCS costs associated with administering the PP- GEMT Program. 4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP for the PP-GEMT Program as permitted by federal law. In the event DHCS is unable to obtain FFP for the PP-GEMT Program, or the full payments cannot otherwise be made to and retained by eligible public providers, and, therefore, all DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES CERTIFICATION FORM FOR STATE CALENDAR YEAR 2025 or a portion of the transferred amount cannot be used as the NFS of payments, DHCS will notify the Public Entity via e-mail and return the applicable portion of the unused IGT amount. 5. The Public Entity acknowledges that, in accordance with W&I Code section 14105.945, subdivision (h)(2), DHCS shall assess a ten percent (10%) fee on each transfer of public funds to the state to pay for health care coverage and to reimburse DHCS its costs associated with administering the PP-GEMT Program. 6. The Public Entity acknowledges that the IGT is to be used by DHCS for the filing of a claim with the federal government for federal funds and understands that any misrepresentation regarding the IGT may violate federal and state law. 7. The amount voluntarily transferred to DHCS is based on the estimated Medi-Cal FFS and Medi-Cal MC NFS of ground emergency medical transport payments, as referenced in paragraph three herein. The amounts to be voluntarily transferred to DHCS will be based on an estimate, the Public Entity acknowledges that a reconciliation of the voluntary NFS contributions to the actual NFS expenditures will occur. To the degree necessary to fund the NFS for the PP-GEMT Program, amounts due to or owed by the Public Entity as a result of the reconciliation may be offset against, or added to, future transfers as applicable and as determined by DHCS. DHCS may accept a voluntary contribution to the extent it is able to obtain FFP for PP-GEMT payments as permitted by federal law. 8. The Public Entity acknowledges that all records of funds transferred are subject to review and audit upon DHCS' request. The Public Entity will maintain documentation supporting the allowable funding source of the IGTs. 9. Upon notice from the federal government of a disallowance or deferral related to this IGT, the Public Entity responsible for this IGT shall be the entity responsible for the federal portion of that expenditure. I hereby declare under penalty of perjury under the law of the United States that the foregoing is true and correct to the best of my knowledge. I further understand that the known filing of a false or fraudulent claim, or making false statements in support of a claim, may violate the Federal False Claims Act or other applicable statute and federal law and may be punishable thereunder. DEPARTMENT OF HEALTH CARE SERVICES PUBLIC PROVIDER INTERGOVERNMENTAL TRANSFER PROGRAM FOR GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES CERTIFICATION FORM FOR STATE CALENDAR YEAR 2025 Executed on this day of a aAQa�( , 2025 at o�� ,P�, California. Signature of Authorized Person: Name of Authorized Person: Grace K. Leung Title of Authorized Person: City Manager Name of Public Entity: City of Newport Beach NPI of Public Entity: 1679579296 Amount of IGT: $82,686.25 Attest: leilani 1. Brown, D P: I.& 10T/ APPROVED AS TO FORM: CITY ATTORNEYS OFFICE Date: 1 Z - /<X -,7 9A Pzd�HCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM MANAGED CARE AND FEE FOR SERVICE - INVOICE Entity Information: Entity Name: 1/17/2025 City Of Newport Beach Payment Details: NPI: Year: 2025 Collection #: 1 1679579296 Total Amount Due: $82,686.25 Program/Payee Information: Banking information: Vendor Name: Bank Name, California Department of Health Care Services US Bank Please await Wire Request Memo for payment instructions PP-GEMT Program Email: Payment methods Accepted: AB1705CZDdhcs.ca.gov ACH or Wire Transfer Payment instructions: Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification form by January 3, 2025, to AB1705@dhcs.ca.gov. IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions. Please do not send your IGT payment until you have received the Wire Request Memo as payment details are subject to change. Managed Care (MC) MC NFS #1 $71,549.02 MC Admin Fee #1 $0.00 Fee For Service (FFS) FFS NFS #1 $11,137.23 FFS Admin Fee #1 $0.00 Total* IGT Transfer Amount: $82,686.25 *Any differences are due to rounding. CY 2025 Invoicing Schedule CY 2025 Invoice #1 Invoice Packets Sent 1 12/3/2024 IGT Certifications Due 1/3/2025 Payment Due 1/17/2025 CY 2025 Invoice #2 Invoice Packets Sent 3/4/2025 IGT Certifications Due 4/4/2025 Payment Due 4/18/2025 CY 2023 FFS Recon Date of Service Jan - Dec 2023 CY 2024 MC Recon #1 Date of Service Jan - Jun 2024 CY 2025 Invoice 43 Invoice Packets Sent 6/3/2025 1GT Certifications Due 7/4/2025 Pa ment Due 7/18/2025 CY 2025 Invoice #4 Invoice Packets Sent 9/2/2025 IGT Certifications Due 10/3/2025 Payment Due 10/17/202S CY 2024 MC Recon #2 Date of Service Jul - Dec 2024 kvHCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 I, the undersigned, hereby declare and certify on behalf of CITY OF NEWPORT BEACH (the "Public Entity") as follows: 1. As a public administrator, a public officer, or other public individual, I am duly authorized to make this certification. 2. The Public Entity elects to make this intergovernmental transfer (IGT) to the Department of Health Care Service (DHCS) as a voluntary contribution to the non-federal share (NFS) of Medi-Cal expenditures for purposes of Assembly Bill 1705 (2019) pursuant to Sections 14105.94, 14105.945, 14129, 14129.3, and 14164 of the Welfare and Institutions (W&I) Code. All funds transferred pursuant to this certification qualify for federal financial participation (FFP) pursuant to Section 1903(w) of the Social Security Act and Title 42 of the Code of Federal Regulations, Section 433 Subpart B, and are not derived from impermissible sources such as recycled Medicaid payments, federal money excluded from use as the NFS, impermissible health care -related taxes, or non -bona fide provider - related donations. 3. Voluntary contributions attributable to the period of January 1, 2023, through December 31, 2025, will be made via recurring transfers as indicated on the invoices provided to the Public Entity by DHCS. The voluntary contributions made by the Public Entity may also include adjustments related to the CY 2023 and CY 2024 rating period's NFS reconciliation as described in paragraph 7 below. Please note, the total IGT amount at the bottom of this IGT certification will continue to be itemized on your invoice which is sent to you along with this IGT certification form 45-days in advance of the IGT contribution due date. The Public Entity acknowledges that any transfers made pursuant to this certification during this time period are considered an elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to be used by DHCS, subject to paragraph four herein, exclusively as the source for the NFS of ground emergency medical transport public provider supplemental payments in both Medi-Cal fee for service California Department of Health Care Services State of California s a, Capitated Rates Development Division Gavin Newsom, Governor 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 (FFS) payments and the portion of the risk -based capitation rate to Medi-Cal managed care health plans associated with reimbursement made in accordance with Section 14105.945, subdivision (h)(1) (hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Transportation (GEMT) Program, or the PP-GEMT Program), and DHCS costs associated with administering the PP-GEMT Program. 4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP for the PP-GEMT Program as permitted by federal law. In the event DHCS is unable to obtain FFP for the PP-GEMT Program, or the full payments cannot otherwise be made to and retained by eligible public providers, and, therefore, all or a portion of the transferred amount cannot be used as the NFS of payments, DHCS will notify the Public Entity via e-mail and return the applicable portion of the unused IGT amount. 5. The Public Entity acknowledges that state law in W&I Code section 14105.945, subdivision (h)(2) authorizes DHCS, upon obtaining any necessary approvals, to assess a ten percent (10%) fee on each transfer of public funds to the state to pay for health care coverage and to reimburse DHCS its costs associated with administering the PP-GEMT Program. The Public Entity acknowledges that while DHCS is not assessing this fee currently pending federal approval, DHCS has not waived its right to assess the administrative fee under state law upon obtaining any necessary federal approvals. 6. The Public Entity acknowledges that the IGT is to be used by DHCS for the filing of a claim with the federal government for federal funds and understands that any misrepresentation regarding the IGT may violate federal and state law. 7. The amount voluntarily transferred to DHCS is based on the estimated Medi-Cal FFS and Medi-Cal managed care NFS of ground emergency medical transport payments, as referenced in paragraph three herein. Since the amount to be voluntarily transferred to DHCS will be based on an estimate, the Public Entity acknowledges that a reconciliation of the voluntary NFS contributions to the actual NFS expenditures will occur. To the degree necessary to fund the NFS for the PP-GEMT Program, amounts due to or owed by Public Entity as a result of the reconciliation may be offset against, or added to, future transfers as applicable California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov State of California Gavin Newsom, Governor California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 and as determined by DHCS. DHCS may accept a voluntary contribution to the extent it is able to obtain FFP for PP-GEMT payments as permitted by federal law. 8. The Public Entity acknowledges that all records of funds transferred are subject to review and audit upon DHCS' request. The Public Entity will maintain documentation supporting the allowable funding source of the IGTs. 9. Upon notice from the federal government of a disallowance or deferral related to this IGT, the Public Entity responsible for this IGT shall be the entity responsible for the federal portion of that expenditure. I hereby declare under penalty of perjury under the law of the United States that the foregoing is true and correct to the best of my knowledge. I further understand that the known filing of a false or fraudulent claim, or making false statements in support of a claim, may violate the Federal False Claims Act or other applicable statute and federal law and may be punishable thereunder. Executed on this day of 2025 at California. Signature of Authorized Person: — -�5� Name of Authorized Person. GR�EK.LEUNG Title of Authorized Person: CITY MANAGER Name of Public Entity: CITY OF NEWPORT BEACH NPI of Public Entity: 1679579296 Amount of IGT: $ 111,169.86 APPROVED AS TO FORM: CITY ATTORNEY'S OFFICE Date.-. Molly Perry` Interim City Clerk By: rZ� a n . Harp, City Attorney ti� ,ti5 California Department of Health Care Services State of California Capitated Rates Development Division Gavin Newsom, Governor 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov California Health and Human Services Agency ►HCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM MANAGED CARE AND FEE FOR SERVICE - INVOICE Entity Information: Due Date: 7/1s/2ozs Entity Name: City Of Newport Beach Payment Details: Year: 2025 Contribution #: 3 NPI: 1679579296 Total Amount Due: $111,169.86 Program/Payee Information: Banking Information: Vendor Name: Bank Name: California Department of Health Care Services US Bank Please await Wire Request Memo for payment instructions PP-GEMT Program Email: Payment Methods Accepted: AB1705C@dhcs.ca.gov JACH or Wire Transfer Payment Instructions; Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification form by July 4, 2025, to AB1705@dhcs.ca.gov. IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions. Please note, July 4 is a holiday and State offices will be closed so please plan accordingly. Please do not send your IGT payment until you have received the Wire Request Memo as payment details are subject to change. Managed Care (MC) MC NFS #3 $ 71,936.09 MC Reconciliation #1(Jan - Jun 2024) $ 37,067.51 Fee For Service (FFS) FFS NFS #3 $ 11,164.63 FFS Reconciliation #1(Jan -Jun 2023) $ (8,998.37) Total* IGT Transfer Amount: $ 111,169.86 are due to rounding. CY 2025 Invoice #1 Invoice Packets Sent 12/3/2024 IGT Certifications Due 1/3/2025 Payment Due 1/17/2025 CY 2025 Invoice #2 Invoice Packets Sent 3/4/2025 IGT Certifications Due 4/4/2025 Payment Due 4/18/2025 CY 2025 Invoice #3 Invoice Packets Sent 6/3/2025 IGT Certifications Due 7/4/2025 Payment Due 7/18/2.25 CY 2023 FFS Recon #1 Date of Service Jan - Jun 2023 CY 2024 MC Recon 91 Date of Service Jan - Jun 2024 CY 2025 Invoice #4 Invoice Packets Sent 9/2/2025 IGT Certifications Due 10/3/2025 Payment Due 10/17/2025 CY 2023 FFS Recon #2 Date of Service Jul - Dec 2023 CY 2024 MC Recon #2 Date of Service Jul - Dec 2024 *Schedule subject to change kv H C S CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES PP-GEMT MANAGED CARE NON-FEDERAL SHARE RECONCILIATION Background Effective January 1, 2023, the Department of Health Care Services (DHCS) implemented the Public Provider Ground Emergency Medical Transport (PP-GEMT) Program. The non- federal share (NFS) of Medi-Cal expenditures for the PP-GEMT Program is supported by voluntary intergovernmental transfer (IGT) contributions. The amount voluntarily transferred by participating funding entities is based on the estimated Medi-Cal fee -for - service (FFS) and Medi-Cal managed care (MC) non-federal share of PP-GEMT payments. For further detail regarding voluntary IGT contributions, please refer to the IGT Certification form available on the PP-GEMT website. Scope The PP-GEMT reconciliation will only apply to funding entities who contributed to the applicable PP-GEMT rating period. To the degree necessary to fund the NFS for the PP- GEMT Program, amounts due to or owed by applicable Public Entities as a result of the reconciliation will be offset against, or added to, future transfers as applicable and as determined by DHCS. Should a provider elect to receive their offset amount in a different manner, they are able to notify AB1705@dhcs.ca.gov. Timing The PP-GEMT MC reconciliation will be conducted on a bi-annual basis for each prior rating period. DHCS will reconcile two (2) six-month service periods at a time. Methodology Voluntary MC NFS collections for the applicable rating period will be reconciled against the actual NFS that was paid by DHCS to managed care plans (MCPs). Please note the following: • Collections associated with the PP-GEMT administrative fee will also be adjusted in the reconciliation as those are assessed on NFS collection amounts. Unlike the FFS delivery system, MC does not reconcile on a provider claim basis. &F`HCS CAUFORNIA DEPARTMENT OF HEALTH CARE SERVICES Changes to the NFS identified during the reconciliation process will result in over/under adjustments included as a line -item on provider invoices. Providers no longer participating as a funding entity will be contacted as there is no invoice to adjust. Please see an example below, which is being provided for illustrative purposes only: Service Period NFS Collected MCP NFL Payment Difference* Jan-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 Feb-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 Mar-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 Reconciliation #1 Apr-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 May-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 Jun-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 $ 60,000.00 *Difference displayed in the above example indicates $60,000 is awed to providers. Service Period NFS Collected MCP NFS Payment Difference* Jul-23 $ 90,000.00 $ 100,000.00 $ (10,000.00) Aug-23 $ 90,000.00 $ 100,000.00 $ (10,000.00) Sep-23 5 90,000.00 $ 100,000.00 $ (10,000.00) Reconciliation #2 Oct-23 $ 90,000.00 $ 100,000.00 $ (10,000.00) Nov-23 $ 901,000.00 $ 100,000.00 $ (10,000.00) Dec-23 5 90,000.00 $ 100,000.00 $ (10,000.00) $ (60,000.00) 'Difference displayed in the above example indicates $60,000 is owed to DHCS. In the MC delivery system, capitation rates may be amended. To the extent that a rate amendment results in a retroactive adjustment to MCP PP-GEMT payments, further adjustments to that service period's reconciliation may be made. Pb H C S CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 I, the undersigned, hereby declare and certify on behalf of CITY OF NEWPORT BEACH (the "Public Entity") as follows: 1. As a public administrator, a public officer, or other public individual, I am duly authorized to make this certification. 2. The Public Entity elects to make this intergovernmental transfer (IGT) to the Department of Health Care Service (DHCS) as a voluntary contribution to the non-federal share (NFS) of Medi-Cal expenditures for purposes of Assembly Bill 1705 (2019) pursuant to Sections 14105.94, 14105.945, 14129, 14129.3, and 14164 of the Welfare and Institutions (W&I) Code. All funds transferred pursuant to this certification qualify for federal financial participation (FFP) pursuant to Section 1903(w) of the Social Security Act and Title 42 of the Code of Federal Regulations, Section 433 Subpart B, and are not derived from impermissible sources such as recycled Medicaid payments, federal money excluded from use as the NFS, impermissible health care -related taxes, or non -bona fide provider - related donations. 3. Voluntary contributions attributable to the period of January 1, 2023, through December 31, 2025, will be made via recurring transfers as indicated on the invoices provided to the Public Entity by DHCS. The voluntary contributions made by the Public Entity may also include adjustments related to the CY 2023 and CY 2024 rating period's NFS reconciliation as described in paragraph 7 below. Please note, the total IGT amount at the bottom of this IGT certification will continue to be itemized on your invoice which is sent to you along with this IGT certification form 45-days in advance of the IGT contribution due date. The Public Entity acknowledges that any transfers made pursuant to this certification during this time period are considered an elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to be used by DHCS, subject to paragraph four herein, exclusively as the source for the NFS of ground emergency medical transport public provider supplemental payments in both Medi-Cal fee for service California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov State of California Gavin Newsom, Governor California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 (FFS) payments and the portion of the risk -based capitation rate to Medi-Cal managed care health plans associated with reimbursement made in accordance with Section 14105.945, subdivision (h)(1) (hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Transportation (GEMT) Program, or the PP-GEMT Program), and DHCS costs associated with administering the PP-GEMT Program. 4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP for the PP-GEMT Program as permitted by federal law. In the event DHCS is unable to obtain FFP for the PP-GEMT Program, or the full payments cannot otherwise be made to and retained by eligible public providers, and, therefore, all or a portion of the transferred amount cannot be used as the NFS of payments, DHCS will notify the Public Entity via e-mail and return the applicable portion of the unused IGT amount. -5--The-Public-Entity-acknowledges-that state -law -in-WW Code -section 14105.945, - -- subdivision (h)(2) authorizes DHCS, upon obtaining any necessary approvals, to assess a ten percent (10%) fee on each transfer of public funds to the state to pay for health care coverage and to reimburse DHCS its costs associated with administering the PP-GEMT Program. The Public Entity acknowledges that while DHCS is not assessing this fee currently pending federal approval, DHCS has not waived its right to assess the administrative fee under state law upon obtaining any necessary federal approvals. 6. The Public Entity acknowledges that the IGT is to be used by DHCS for the filing of a claim with the federal government for federal funds and understands that any misrepresentation regarding the IGT may violate federal and state law. 7. The amount voluntarily transferred to DHCS is based on the estimated Medi-Cal FFS and Medi-Cal managed care NFS of ground emergency medical transport payments, as referenced in paragraph three herein. Since the amount to be voluntarily transferred to DHCS will be based on an estimate, the Public Entity acknowledges that a reconciliation of the voluntary NFS contributions to the actual NFS expenditures will occur. To the degree necessary to fund the NFS for the PP-GEMT Program, amounts due to or owed by Public Entity as a result of the reconciliation may be offset against, or added to, future transfers as applicable California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 195899-7413 MS 4413 1 www.dhcs.ca.gov State of California Gavin Newsom, Governor California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 and as determined by DHCS. DHCS may accept a voluntary contribution to the extent it is able to obtain FFP for PP-GEMT payments as permitted by federal law. 8. The Public Entity acknowledges that all records of funds transferred are subject to review and audit upon DHCS' request. The Public Entity will maintain documentation supporting the allowable funding source of the IGTs. 9. Upon notice from the federal government of a disallowance or deferral related to this IGT, the Public Entity responsible for this IGT shall be the entity responsible for the federal portion of that expenditure. I hereby declare under penalty of perjury under the law of the United States that the foregoing is true and correct to the best of my knowledge. I further understand that the known filing of a false or fraudulent claim, or making false statements in support of a claim, may violate the Federal False Claims Act or other applicable statute and federal law and may be punishable thereunder. Executed on this Sr' day of 2025 at ���`�� �"'� ` California. Signature of Authorized Person: Name of Authorized Person: GR E K. LEUNG Title of Authorized Person: CITY MANAGER Name of Public Entity: CITY OF NEWPORT BEACH NPI of Public Entity: 1679579296 Amount of IGT: $ 111,169.86 APPROVED AS TO FORM: CITY ATTORNEYS OFFICE Date: '� 26 BY • ( b� 1 • a n . Harp, City Attorney tiV ,tip X California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 195899-7413 MS 4413 1 www.dhcs.ca.gov Z' Molly Perry Interim City Clerk t� tS/ Ltd-..; •�`H C.',fit 1 State of California Gavin Newsom, Governor California Health and Human Services Agency PVHCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM MANAGED CARE AND FEE FOR SERVICE - INVOICE Entity Information: Due •. 7/18/2o2s Entity Name: City Of Newport Beach Payment Details: Year: 2025 Contribution #: 3 NPI: 1679579296 Total Amount Due: $111,169.86 Program/Payee Information: Banking Information: Vendor Name: Bank Name: California Department of Health Care Services US Bank Please await Wire Request Memo for payment instructions PP-GEMT Program Email: Payment Methods Accepted: AB1705@dhcs.ca.gov JACH or Wire Transfer Payment Instructions: Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification form by July 4, 2025, to AB1705@dhcs.ca.gov. IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions. Please note, July 4 is a holiday and State offices will be closed so please plan accordingly. Please do not send your IGT payment until you have received the Wire Request Memo as payment details are subject to change. IGT Non -Federal Share (NFS) Breakdown By DHCS Delivery System Care (MC) MC NFS #3 $ 71,936.09 MC Reconciliation #1 (Jan -Jun 2024) $ 37,067.51 Fee For Service (FFS) FFS NFS#3 $ 11,164.63 FFS Reconciliation #1 (Jan - Jun 2023) $ (8,998.37) Total* IGT Transfer Amount: $ 111,169.86 *Any differences are due to rounding. CY 2025 Invoice #1 Invoice Packets Sent 12/3/2024 IGT Certifications Due 1/3/2025 Payment Due 1/17/2025 CY 2025 Invoice #2 Invoice Packets Sent 3/4/2025 IGT Certifications Due 4/4/2025 Payment Due 4/18/2025 CY 2025 Invoice #3 Invoice Packets Sent 6/3/2025 IGT Certifications Due 7/4/2025 Payment Due 7/18/2025 CY 2023 FFS Recon #1 Date of Service Jan - Jun 2023 CY 2024 MC Recon Jtl Date of Service Jan - Jun 2024 CY 2025 Invoice #4 Invoice Packets Sent 9/2/2025 IGT Certifications Due 10/3/2025 Payment Due 10/17/2025 CY 2023 FFS Recon JtZ Date of Service Jul - Dec 2023 CY 2024 MC Recon #2 Date of Service Jul - Dec 2024 *Schedule subject to change P&HCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES PP-GEMT MANAGED CARE NON-FEDERAL SHARE RECONCILIATION Background Effective January 1, 2023, the Department of Health Care Services (DHCS) implemented the Public Provider Ground Emergency Medical Transport (PP-GEMT) Program. The non- federal share (NFS) of Medi-Cal expenditures for the PP-GEMT Program is supported by voluntary intergovernmental transfer (IGT) contributions. The amount voluntarily transferred by participating funding entities is based on the estimated Medi-Cal fee -for - service (FFS) and Medi-Cal managed care (MC) non-federal share of PP-GEMT payments. For further detail regarding voluntary IGT contributions, please refer to the IGT Certification form available on the PP-GEMT website. Scope The PP-GEMT reconciliation will only apply to funding entities who contributed to the applicable PP-GEMT rating period. To the degree necessary to fund the NFS for the PP- GEMT Program, amounts due to or owed by applicable Public Entities as a result of the reconciliation will be offset against, or added to, future transfers as applicable and as determined by DHCS. Should a provider elect to receive their offset amount in a different manner, they are able to notify AB1705@dhcs.ca.gov. Timing The PP-GEMT MC reconciliation will be conducted on a bi-annual basis for each prior rating period. DHCS will reconcile two (2) six-month service periods at a time. Methodology Voluntary MC NFS collections for the applicable rating period will be reconciled against the actual NFS that was paid by DHCS to managed care plans (MCPs). Please note the following: • Collections associated with the PP-GEMT administrative fee will also be adjusted in the reconciliation as those are assessed on NFS collection amounts. Unlike the FFS delivery system, MC does not reconcile on a provider claim basis. NvHCS CAUFORNIA DEPARTMENT OF HEALTH CARE SERVICES Changes to the NFS identified during the reconciliation process will result in over/under adjustments included as a line -item on provider invoices. Providers no longer participating as a funding entity will be contacted as there is no invoice to adjust. Please see an example below, which is being provided for illustrative purposes only: Service Period NFS Collected MCP NFS Payment Difference* Jan-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 Feb-23 $ 100,000.00 S 90,000.00 $ 10,000.00 Mar-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 Reconciliation #1 Apr-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 May-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 Jun-23 $ 100,000.00 $ 90,000.00 $ 10,000.00 $ 66,000.00 *'Difference displayed in the above example indicates $60,000 is owed to providers. Service Period NFS Collected MCP NFS Payment Difference* Jul-23 S 90,000.00 $ 100,000.00 $ (10,000.00) Aug-23 $ 90,000.00 $ 100,000.00 $ (10,000.00) Sep-23 5 90,000.00 $ 100,000.00 S (10,000.00) Reconciliation #2 Oct-23 $ 90,000.00 $ 100,000.00 $ (10,000.00) Nov-23 $ 90,000.00 $ 100,000.00 S (10,000.00) Dee-23 5 90,000.00 $ 100,000.00 $ (10,000.00) $ (60.000.00) *'Difference displayed in the above example indicates $60,000 is owed to DNCS. In the MC delivery system, capitation rates may be amended. To the extent that a rate amendment results in a retroactive adjustment to MCP PP-GEMT payments, further adjustments to that service period's reconciliation may be made. ►DHCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 I, the undersigned, hereby declare and certify on behalf of THE CITY OF NEWPORT BEACH (the "Public Entity") as follows: 1. As a public administrator, a public officer, or other public individual, I am duly authorized to make this certification. 2. The Public Entity elects to make this intergovernmental transfer (IGT) to the Department of Health Care Service (DHCS) as a voluntary contribution to the non-federal share (NFS) of Medi-Cal expenditures for purposes of Assembly Bill 1705 (2019) pursuant to Sections 14105.94, 14105.945, 14129, 14129.3, and 14164 of the Welfare and Institutions (W&I) Code. All funds transferred pursuant to this certification qualify for federal financial participation (FFP) pursuant to Section 1903(w) of the Social Security Act and Title 42 of the Code of Federal Regulations, Section 433 Subpart B, and are not derived from impermissible sources such as recycled Medicaid payments, federal money excluded from use as the NFS, impermissible health care -related taxes, or non -bona fide provider - related donations. 3. Voluntary contributions attributable to the period of January 1, 2023, through December 31, 2025, will be made via recurring transfers as indicated on the invoices provided to the Public Entity by DHCS. The voluntary contributions made by the Public Entity may also include adjustments related to the CY 2023 and CY 2024 rating period's NFS reconciliation as described in paragraph 7 below. Please note, the total IGT amount at the bottom of this IGT certification will continue to be itemized on your invoice which is sent to you along with this IGT certification form 45-days in advance of the IGT contribution due date. The Public Entity acknowledges that any transfers made pursuant to this certification during this time period are considered an elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to be used by DHCS, subject to paragraph four herein, exclusively as the source for the NFS of ground emergency medical transport public provider supplemental payments in both Medi-Cal fee for service California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov State of California Gavin Newsom, Governor California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 (FFS) payments and the portion of the risk -based capitation rate to Medi-Cal managed care health plans associated with reimbursement made in accordance with Section 14105.945, subdivision (h)(1) (hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Transportation (GEMT) Program, or the PP-GEMT Program), and DHCS costs associated with administering the PP-GEMT Program. 4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP for the PP-GEMT Program as permitted by federal law. In the event DHCS is unable to obtain FFP for the PP-GEMT Program, or the full payments cannot otherwise be made to and retained by eligible public providers, and, therefore, all or a portion of the transferred amount cannot be used as the NFS of payments, DHCS will notify the Public Entity via e-mail and return the applicable portion of the unused IGT amount. 5. The Public Entity acknowledges that state law in W&I Code section 14105.945, subdivision (h)(2) authorizes DHCS, upon obtaining any necessary approvals, to assess a ten percent (10%) fee on each transfer of public funds to the state to pay for health care coverage and to reimburse DHCS its costs associated with administering the PP-GEMT Program. The Public Entity acknowledges that while DHCS is not assessing this fee currently pending federal approval, DHCS has not waived its right to assess the administrative fee under state law upon obtaining any necessary federal approvals. 6. The Public Entity acknowledges that the IGT is to be used by DHCS for the filing of a claim with the federal government for federal funds and understands that any misrepresentation regarding the IGT may violate federal and state law. 7. The amount voluntarily transferred to DHCS is based on the estimated Medi-Cal FFS and Medi-Cal managed care NFS of ground emergency medical transport payments, as referenced in paragraph three herein. Since the amount to be voluntarily transferred to DHCS will be based on an estimate, the Public Entity acknowledges that a reconciliation of the voluntary NFS contributions to the actual NFS expenditures will occur. To the degree necessary to fund the NFS for the PP-GEMT Program, amounts due to or owed by Public Entity as a result of the reconciliation may be offset against, or added to, future transfers as applicable California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov State of California r: Gavin Newsom, Governor California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2025 and as determined by DHCS. DHCS may accept a voluntary contribution to the extent it is able to obtain FFP for PP-GEMT payments as permitted by federal law. 8. The Public Entity acknowledges that all records of funds transferred are subject to review and audit upon DHCS' request. The Public Entity will maintain documentation supporting the allowable funding source of the IGTs. 9. Upon notice from the federal government of a disallowance or deferral related to this IGT, the Public Entity responsible for this IGT shall be the entity responsible for the federal portion of that expenditure. I hereby declare under penalty of perjury under the law of the United States that the foregoing is true and correct to the best of my knowledge. I further understand that the known filing of a false or fraudulent claim, or making false statements in support of a claim, may violate the Federal False Claims Act or other applicable statute and federal law and may be punishable thereunder. Executed on this day of , 2025 at , California. Signature of Authorized Person: Name of Authorized Person: G CE K. LEUNG Title of Authorized Person: CITY MANAGER Name of Public Entity: THE CITY OF NEWPORT BEACH NPI of Public Entity: 1679579296 Amount of IGT: $ 110,194.27 APPROVED AS TO FORM: CITY ATTORNEY'S OFFICE By: 7 ar n C. Harp, City Attorney � 1L 2ti %t C California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov Attest (cW Po ty &A State of California 7 Gavin Newsom, Governor11 California Health and Human Services Agency haoHCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM MANAGED CARE AND FEE FOR SERVICE — INVOICE Entity Information: Due .. 1o/v/zozs Entity Name: City Of Newport Beach Payment Details. Year: 2025 Contribution #: 4 NPI: 1679579296 Total Amount Due: $110,194.27 Program/Payee Information: Banking Information: Vendor Name: Bank Name: California Department of Health Care Services US Bank Please await Wire Request Memo for payment instructions PP-GEMT Program Email: Payment Methods Accepted: AB1705@dhcs.ca.gov JACH or Wire Transfer Payment Instructions: Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification form by October 3, 2025, to AB1705@dhcs.ca.gov. IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions. Please do not send your IGT payment until you have received the Wire Request Memo as payment details are subject to change. ,IGT Non -Federal Share (NFS) Breakdown By DIHCS Delivery System Care (MC) MC NFS #4 $ 71,916.70 MC Reconciliation #2 (Jul - Dec 2024) $ 36,122.15 Fee For Service (FFS) FFS NFS #4 $ 11,153.79 FFS Reconciliation #2 (Jul - Dec 2023) $ (8,998.37) Total* IGT Transfer Amount: $ 110,194.27 *Any differences are due to rounding. CY 2025 Invoice #1 Invoice Packets Sent 12/3/2024 IGT Certifications Due 1/3/202S Payment Due 1/17/2025 CY 2025 Invoice #2 Invoice Packets Sent 3/4/2025 IGT Certifications Due 4/4/2025 Payment Due 1 4/18/2025 CY 2025 invoice #3 Invoice Packets Sent 6/3/2025 IGT Certifications Due 7/4/202S Payment Due 7/18/2025 CY 2023 FFS Recon to Date of Service Jan - Jun 2023 CY 2024 MC Recon to Date of Service Jan - Jun 2024 CY 2025 Invoice #4 Invoice Packets Sent 9/2/2025 IGT Certifications Due 10/3/2025 Payment Due 20/17/2025 CY 2023 FFS Recon #2 Date of Service Jul - Dec 2023 CY 2024 MC Recon #2 Date of Service Jul - Dec 2024 'Schedule subject to change