HomeMy WebLinkAboutC-7142-1 - Agreement for Recovery of Administrative Costs for Implementation and Recovery of Ground Emergency Medical Transportation Paymentsi
AGREEMENT FOR RECOVERY OF ADMINISTRATIVE COSTS
v FOR IMPLEMENTATION AND RECOVERY OF GROUND EMERGENCY
MEDICAL TRANSPORTATION PAYMENTS
This agreement is made and entered into on this 1st day of July, 2017,
between the Sacramento Metropolitan Fire District, ("Metro Fire") a political
subdivision of
the State of California and, the City of Newport Beach, a California municipal
corporation and charter city ("GEMT Transporter').
WHEREAS, the State Department of Health Care Services ("State") has developed
and is administering the Medi -Cal Ground Emergency Transportation Supplemental
Reimbursement Program pursuant to the California Welfare and Institutions Code Section
14105.94 ("State Code") and State Plan Amendments ("SPA") 09-024; and,
WHEREAS, the State has entered into an agreement with Metro Fire for
administrative services related to the Medi -Cal Ground Emergency Transportation
Supplemental Reimbursement Program pursuant to the State Code and SPA
09-024 ("State Agreement'), which is attached hereto as Exhibit A, and is incorporated
as if set forth fully herein; and,
WHEREAS under the State Code an eligible provider of ground
emergency medical transportation services may be entitled to supplemental Medi -Cal
reimbursement as set forth in those provisions; and,
WHEREAS an eligible provider as described in the State Code is required to
enter into an agreement to reimburse the State for implementing and
administering the Supplemental Reimbursement Program as a condition of
receiving supplemental reimbursement pursuant to the State Code; and,
WHEREAS pursuant to the State Agreement, Metro Fire has been designated by
the State to recover the administrative and implementation costs required to be paid by
eligible providers under the State Code; and,
WHEREAS Metro Fire will incur administrative and other costs in connection with
billing GEMT Transporter for costs, and has assumed the risk of payment, or non-
payment of the costs from GEMT Transporter;
NOW therefore, the Parties enter into this Agreement for the purpose of
setting forth the manner and terms for payment of administrative costs by the eligible
GEMT providers to Metro Fire, under the following terms and conditions.
Page 1 of 7
PARTIES
Metro Fire is a designated agency for
Supplemental Medi -Cal Reimbursement
provider of GEMT services as described
II. TERMS
the collection of costs related to the GEMT
Program. GEMT Transporter is an eligible
in the State Code.
This Agreement shall be effective and commence as of July 1, 2017 and shall end on
June 30, 2020. However, GEMT transporter acknowledges and agrees that cost reports
submitted by GEMT Transporters are subject to audit by the State of California for a
period of thirty-six (36) months from the date of submission of the reports by the GEMT
Transporter to the State of California. During that period of time, State administrative
costs as defined in the State Code will continue to be incurred by the State for which the
GEMT Transporter agrees to pay to Metro Fire pursuant to Section IV below. The GEMT
Transporter agrees to pay its transporter share of administrative costs pursuant to Section
V. after the termination of this Agreement, whether this Agreement is terminated by its
term, or in the event GEMT Transporter elects to terminate the Agreement, or in the event
that Metro Fire terminates the Agreement.
III. RATIFICATION
Where there has been a need for Metro Fire to provide services essential to the GEMT
program in the State of California and where such services have been provided prior to
the date of execution of this Agreement, both Parties agree that the calculation, and
payment, of services under this Agreement shall begin on July 1, 2017.
IV. SCOPE OF SERVICES AND RESPONSIBILITIES
Metro Fire will provide the following services:
A. Advance of GEMT administration costs to the State as provided by SPA
09-024 on behalf of the GEMT Transporter.
B. Assistance to the State GEMT program on behalf of the GEMT
Transporters including:
a. Cost Report development
b. Information resource to the State and Federal governments
c. Program development to expand the scope of eligible costs
C. Assistance to the GEMT Transporter including:
a. General (offsite) program assistance
b. Ombudsman services when needed
c. Advocate for reimbursements
d. Government relations
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The GEMT Transporter will provide the following services:
A. Accurate reports of transports eligible under the GEMT program
B. Accurate record keeping and retention of records for a period of not less than
seven (7) years
C. Provide all records upon request for audit purposes
V. PAYMENT TERMS
GEMT Transporter agrees to pay Metro Fire the transporter's share of the State
administrative costs as defined in the State Code. The GEMT transporter share will be
based upon the administrative costs per fee for service Medi -Cal transport, multiplied by
the GEMT Transporter's number of fee for service Medi -Cal transports for each reporting
period. The administrative costs per fee for service Medi -Cal transport will be determined
by the State of California based on the total administrative costs of the State in
administering the GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
SUPPLEMENTAL REIMBURSEMENT PROGRAM divided by the total number of fee for
service Medi -Cal transports statewide by all participating transporter agencies for each
reporting period. In addition, the GEMT transporter will compensate Metro Fire one
percent (1%) of the GEMT transporter's gross State Supplemental Reimbursement of
GEMT services under the State Code for each reporting period for Metro Fire's program
services, administrative services, expansion of program for future reimbursements,
contracting services, other expenses, cost of advancing funds for the State, and the risk
of non-payment from GEMT Transporters.
A. Metro Fire will notify, via email, the amount due under Section V. of this
Agreement by the GEMT Transporter once the amount is determined.
B. All amounts due under this Agreement will be paid to Metro Fire no later
than 30 days after the first notification is sent to the GEMT Transporter via one
of the following methods: ACH/EFT, warrant from Invoice, or Credit Card
C. Non-payment by the GEMT Transporter constitutes a breach of this
Agreement and, if not cured, will result in a termination of this Agreement
pursuant to Section XII below.
1. A breach of this Agreement may be cured by the successful
completion of the payment transaction to Metro Fire by GEMT Transporter
within 30 days' notice by Metro Fire.
2. The State will not provide GEMT supplemental reimbursements to
the GEMT Transporter without a valid Agreement for Recovery of
Administrative Costs for Implementation and Recovery of GEMT Payments
with Metro Fire.
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VI. REIMBURSEMENT COSTS ACKNOWLEDGMENT
The GEMT Transporter acknowledges and agrees that the compensation paid to Metro
Fire pursuant to this Agreement is intended to cover the costs for administering the
supplemental reimbursement program under Section 14105.94(d) of the State Code. The
compensation payable to Metro Fire is approved by the State, pursuant to the State
Agreement attached as Exhibit A. The GEMT Transporter hereby agrees to waive any
claim, action, or challenge to the payment method for the collection of costs under Section
14105.94(d) of the State Code, in the manner set forth in this Agreement.
VII. DISPUTE RESOLUTION
In the event of a dispute between the Parties in the terms of this Agreement as to any
issue arising under this Agreement, the Parties agree to meet and negotiate in good
faith to resolve such dispute. This shall not limit the Parties' right to pursue any available
remedies at law or in equity.
VIII. MUTUAL INDEMNIFICATION
It is agreed that the GEMT Transporter shall defend, hold harmless and indemnify Metro
Fire, its officers, employees, and agents from any and all claims liability, loss or expense
(including reasonable attorney fees) for injuries or damage to any person and/or any
property which arise out of the terms and conditions of this Agreement and the negligent
or intentional acts or omissions of the GEMT Transporter and its officers, employees or
agents. It is further agreed that Metro Fire shall defend, hold harmless and indemnify the
GEMT Transporter and its officers, employees, and agents from any and all claims
liability, loss or expense (including reasonable attorney fees) for injuries or damage to
any person and/or any property which arise out of the terms and conditions of this
Agreement and the negligent or intentional acts or omissions of Metro Fire, its officers,
employees, or agents.
IX. SEVERABILITY
If any term, condition, or provision of this Agreement is held by a court of competent
jurisdiction to be invalid, void, or unenforceable, the remaining provisions will
nevertheless continue in full force and effect, and shall not be affected, impaired or
invalidated in any way. Notwithstanding the previous sentence, if a decision by a court of
competent jurisdiction invalidates, voids, or renders unenforceable a term, condition, or
provision in this Agreement that is included in the purpose of this Agreement then the
Parties to this Agreement shall either amend this Agreement pursuant to Section X. Or it
shall be terminated.
Page 4 of 7
X. AMENDMENT AND WAIVER
Except as provided herein, no alteration, amendment, variation, or waiver of the terms of
this Agreement shall be valid unless made in writing and signed by both Parties. Waiver
by either party of any default, breach or condition precedent shall not be construed as a
waiver of any other default, breach or condition precedent, or any other right hereunder.
XI. INTERPRETATION
This Agreement shall be deemed to have been prepared equally by both of the Parties,
and the Agreement and its individual provisions shall not be construed or interpreted more
favorably for one party on the basis that the other party prepared it.
XII. TERMINATION
Either of the Parties may terminate this Agreement upon thirty (30) days written notice to
the other party. Notice shall be deemed served on the date of mailing. GEMT
Transporter's responsibility for administrative costs incurred by the State associated with
transporter costs reports and/or the State's audit of those costs shall survive the
termination of the Agreement.
XIII. PRIOR AGREEMENTS
This Agreement constitutes the entire Agreement between Metro Fire and GEMT
Transporter regarding the subject matter of this Agreement. Any prior agreements,
whether oral or written, between Metro Fire and GEMT Transporter regarding the subject
matter of this Agreement are hereby terminated effective immediately upon full execution
of this Agreement.
XIV. INTEGRATION CLAUSE
This Agreement and any exhibits attached hereto shall constitute the entire Agreement
among the Parties to it and supersedes any prior or contemporaneous understanding or
agreement with respect to the services contemplated, and may be amended only by a
written amendment executed by both Parties to this Agreement.
Page 5 of 7
XV. CONTROLLING LAW
The validity of this Agreement and its terms or provisions, as well as the rights and duties
of the Parties hereunder, the interpretation and performance of this Agreement shall be
governed by the laws of the State of California.
[SIGNATURES ON NEXT PAGE]
Page 6 of 7
SACRAMENTO METROPO T N FIRE DISTRICT
Signature:
Amanda Thomas, Chief Financial Officer Date
APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Date: 61Z ���
WI-APIKELIG
so
ATTEST" F f�
Date:
By: �
Leilani V. Brown
City Clerk
GEMT TRANSPORTER: City of
Newport Beach, a California municipal
corporation
Date: 1 /! z
By: C
p,as.h Chip Duncan
drn Fire Chief
[END OF SIGNATURES]
Attachments: Exhibit A — Agreement with the California Department of
Health Care Services for Administrative Services Related to
Medi -Cal Ground Emergency Medical Transportation
Services Supplemental Reimbursement Program,
Dated February 23, 2017.
Page 7 of 7
Page 1 of 8
DHCS #16-93420
AGREEMENT WITH THE CALIFORNIA DEPARTMENT OF HEALTH CARE
SERVICES FOR ADMINISTRATIVE SERVICES RELATED TO MEDI-CAL
GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES
SUPPLEMENTAL REIMBURSEMENT PROGRAM
Parties.
The parties to this Agreement are the Sacramento Metropolitan Fire District (SMFD), in
its capacity as the host entity, and the California Department of Health Care Services
(DHCS).
As authorized by California Welfare and Institutions Code section 14105.94, SMFD acts
as the administrative agency for the Medi -Cal Ground Emergency Medical Transportation
Services (GEMT) Supplemental Reimbursement Program on behalf of all publicly owned
and operated GEMT providers in California participating in the program.
DHCS is the single state agency responsible for administering the California Medical
Assistance Program (Medi—Cal) pursuant to California Welfare and Institutions Code
section 14100.1.
2. Term of the Agreement.
Subject to the provisions of this Agreement, the term of this Agreement shall be from July
1, 2017, through and including, June 30, 2020.
3. Maximum Payable Amount.
In full consideration of DHCS' performance of the services described in Schedule A and
the conditions in Section 6., the amount that SMFD shall be obligated to pay for services
rendered for the term of this Agreement shall not exceed $700,000 each State Fiscal Year
(SFY) beginning SFY 2017-18. The State Fiscal Year begins on July 1st each year and
ends on June 30th.
The maximum payable amount shall be further subject to annual limits not to exceed:
$700,000 - for July 1 St, 2017, through and including June 30th, 2018.
$700,000 - for July 1St, 2018, through and including June 30th, 2019.
$700,000 - for July 1St, 2019, through and including June 30th, 2020.
Purpose of the Agreement.
The purpose of this Agreement is for DHCS to perform the administrative services related
to administering the GEMT supplemental reimbursement program as described in
Schedule A, attached hereto and incorporated by reference herein. Further, the purpose
of this agreement is to designate SMFD as the host entity that will collect administrative
costs, as defined in Welfare and Institutions Code section 14105.94, subdivision (d),
pursuant to written contracts between SMFD and eligible providers. The eligible providers
are required to enter into written contracts by the Provider Participation Agreement, which
are entered into between the eligible providers and DHCS. The Provider Participation
Page 2 of 8 DHCS #16-93420
Agreement between the eligible providers and DHCS requires the eligible providers to
satisfy their responsibilities for reimbursing DHCS for its administrative costs by
conditioning their participation in the supplemental payment program and their receipt of
such supplemental funds upon entering into the written reimbursement contracts between
SMFD and the eligible providers for the payment of DHCS' administrative costs, the
subject of this Agreement. It is understood by both SMFD and DHCS that payments set
forth under this Agreement are for the purpose of reimbursing DHCS for all direct and
indirect expenses related to performing these activities.
Contact Persons.
Any notice, request, demand or other communication required or permitted hereunder,
shall be deemed to be properly given when deposited in the United States mail, postage
prepaid, and addressed:
In the case of SMFD, to:
GEMT Coordinator
Sacramento Metropolitan Fire District
Attn: Chief Financial Officer
10545 Armstrong Avenue, Suite 200
Mather, CA 95655
Or to such person or address as SMFD may, from time to time, furnish in writing to DHCS.
In the case of DHCS, to:
California Department of Health
Safety Net Financing Division
Attn: Shiela Mendiola, Medi -Cal
1501 Capitol Avenue, MS 4504
P.O. Box 997436
Sacramento, CA 95899-7436
Care Services
Supplemental Payment Section
Or to such person or address as DHCS may, from time to time, furnish in writing to SMFD.
6. Payment Terms and Invoicing.
A. SMFD shall compensate DHCS for services listed in Schedule A, as authorized by
Section 7 of this agreement, within forty-five (45) days of receipt of an invoice from
DHCS, which specifies both the total federally claimable administrative cost and the
nonfederal share of the total cost.
B. Failure by SMFD to timely compensate DHCS pursuant to paragraph A shall
constitute a material breach of this Agreement by SMFD, which at DHCS'
discretion, may result in termination by DHCS pursuant to Section 9. SMFD may
cure such breach by rendering payment of the amount owed to DHCS prior to the
termination of this Agreement pursuant to Section 9, at which point such notice of
termination shall be automatically rescinded.
Page 3 of 8
DHCS #16-93420
C. In no event shall payment be made by SMFD for any invoice or portion thereof
exceeding the Agreement amount specified in Section 3. Payment for any services
rendered by DHCS exceeding the Agreement amount shall require an amendment
to this Agreement pursuant to Section 8. Services rendered by DHCS shall cease
until an amendment is executed.
D. DHCS shall submit annual invoices to SMFD no sooner than forty-five (45) days
following the close of each SFY. DHCS' invoice shall include the supplemental form
identifying the following summarized categories of costs for the period billed: salary,
benefits, operating expenses, and total costs.
E. SMFD shall not be obligated to pay DHCS for the administrative services covered
by any invoice if DHCS presents the invoice to SMFD more than one (1) year after
this Agreement terminates.
F. Payments shall be sent to DHCS at the following address:
California Department of Health Care Services
Safety Net Financing Division
Attn: Medi -Cal Supplemental Payment Sectior
1501 Capitol Avenue, MS 4504
P.O. Box 997436
Sacramento, CA 95899-7436
7. Scope of Work.
In consideration of the payments hereinafter set forth, DHCS shall perform the activities
related to administering the GEMT supplemental reimbursement program as described
in Schedule A, attached hereto and incorporated by reference herein. It is understood by
both SMFD and DHCS that payments set forth under this Agreement are for the purpose
of reimbursing DHCS for all direct and indirect expenses related to performing these
activities. Should the scope of work or services to be performed under this Agreement
conflict with DHCS' responsibilities as the single agency for Medicaid in California (Medi -
Cal), the single state agency responsibilities shall take precedence. DHCS' cessation of
any activities due to single state agency responsibilities does not relinquish the obligation
of SFMD to reimburse DHCS for administrative costs actually incurred by DHCS.
Amendments.
Amendments to this Agreement shall be made only by a written agreement signed by the
parties to this Agreement, and if required by State law, by approval of the California
Department of General Services. Notwithstanding the previous sentence, updates on who
will serve as the contact person identified in Section 5 may be transmitted by email to the
other contact person or persons. In conformance with state law requiring SMFD to pay
the State for the nonfederal share of its federally reimbursable administrative costs in
administering the GEMT supplemental reimbursement program, by entering into this
Agreement, SMFD acknowledges and accepts that this Agreement shall be automatically
amended to reflect updates to the State's administrative costs.
Page 4 of 8
9. Termination.
DHCS #16-93420
This Agreement may be terminated by any party upon written notice given at least thirty
(30) calendar days prior to the termination date. Notice shall be addressed to the
respective parties as identified in Section 5 of this Agreement. SMFD shall be obligated
to pay for all of the administrative costs incurred from the services duly performed by
DHCS until the termination date.
The terms of Section 6 (Payment Terms and Invoicing), the last sentence of Section 9
(termination), Section 10A (Indemnification), and Section 10C (Records) shall survive the
termination of this Agreement.
10. General Provisions.
A. Indemnification. It is agreed that SMFD shall defend, hold harmless, and indemnify
DHCS, its officers, employees, and agents from any and all claims, liability, loss or
expense (including reasonable attorney fees) for injuries or damage to any person
and/or any property which arise out of the terms and conditions of this Agreement
and the negligent or intentional acts or omissions of SMFD, its officers, employees,
or agents.
B. Severability. If any term, condition, or provision of this Agreement is held by a
court of competent jurisdiction to be invalid, void, or unenforceable, the remaining
provisions will nevertheless continue in full force and effect, and shall not be
affected, impaired or invalidated in any way. Notwithstanding the previous
sentence, if a decision by a court of competent jurisdiction invalidates, voids, or
renders unenforceable a term, condition, or provision in this Agreement that is
included in the purpose of this Agreement then the parties to this Agreement shall
either amend this Agreement pursuant to Section 8, or it shall be terminated.
C. Records.
1) Upon written notice, DHCS agrees to provide to SMFD, or any federal or
State department having monitoring or reviewing authority, access to and
the right to examine and audit its applicable records and documents for
compliance with relevant federal and State statutes, rules and regulations,
and this Agreement.
2) DHCS shall maintain and preserve all records relating to this Agreement for
a period of three (3) years from receipt of the last payment of federal
financial participation (FFP) or until audit findings are resolved, whichever
is greater.
D. Compliance with Applicable Laws. All services to be performed by DHCS pursuant
to this Agreement shall be performed in accordance with all applicable federal and
State laws, including, but not limited to:
1) The Americans with Disabilities Act of 1990, as amended;
2) Section 504 of the Rehabilitation Act of 1973, as amended;
3) Title 42, United States Code (U.S.C.) § 1396 et seq.;
4) Welfare and Institutions Code (W&I), § 14000 et seq;
Page 5 of 8
DHCS 416-93420
5) Government Code § 53060;
6) The California Medicaid State Plan;
7) Laws and regulations including, but not limited to licensure, certification,
confidentiality of records, quality assurance, and nondiscrimination.
E. Controlling law. The validity of this Agreement and its terms or provisions, as well
as the rights and duties of the parties hereunder, the interpretation and
performance of this Agreement shall be governed by the laws of the State of
California.
F. Integration Clause. Notwithstanding the GEMT supplemental reimbursement
program Provider Participation Agreement in Section G. listed below and the
DHCS Form 6208 signed by SMFD, this Agreement and any exhibits attached
hereto shall constitute the entire agreement among the parties to it and supersedes
any prior or contemporaneous understanding or agreement with respect to the
services contemplated.
G. Provider Participation Agreement. This Agreement does not alter, amend, or
override any of the eligible provider's obligations and SMFD's obligations
contained in the Provider Participation Agreement. The Provider Participation
Agreement is an agreement between DHCS and each of the eligible providers,
including SMFD in its capacity as an eligible provider. The Provider Participation
Agreement provides the terms and conditions for the eligible providers to
participate in the supplemental payment program. Such terms and conditions
include, but are not limited to, (i) the requirement that the eligible providers
reimburse SMFD for their share of the administrative costs incurred by DHCS in
administering the supplemental payment program authorized in section 14105.94,
subdivision (d), and (ii) the term that DHCS shall immediately and automatically
without prior notice cease making supplemental payments and initiate a recovery
effort against an eligible provider that fails to pay its administrative costs pursuant
to the terms of the Provider Participation Agreement.
H. Periodic Assessment. Pursuant to 14105.94, subdivision (d), SMFD enters into
this Agreement in order to implement the GEMT supplemental reimbursement
program under which its eligible facilities may participate and for which SMFD will
pay for the nonfederal share of all federally reimbursable administrative costs
incurred by DHCS performing activities described in Section 7. SFMD agrees that
DHCS may conduct a periodic assessment, as determined by DHCS, of such costs
incurred by DHCS to determine compliance with Welfare and Institutions Code
section 14105.94, subdivision (d), and further agrees that all invoicing as described
in Section 6 and any other relevant documentation will be accordingly updated to
ensure compliance with Welfare and Institutions Code section 14105.94,
subdivision (d).
Conformance Clause. This Agreement is entered in accordance with Welfare and
Institutions Code section 14105.94, subdivision (d). Any provision of this
Agreement in conflict with the present orfuture governing authorities of the Welfare
and Institutions Code or other applicable state law or federal law and rules,
including but not limited to, Title XIX of the Social Security Act, California's
Medicaid State Plan, implementation directives promulgated by DHCS, and
implementation directives promulgated by the Centers for Medicare & Medicaid
Page 6 of 8
DHCS #16-93420
Services, is hereby amended to conform to those authorities. Such amended
provisions supersede any conflicting provision in this Agreement.
The persons signing this Agreement on behalf of SMFD and DHCS, as applicable,
represent and warrant that he or she is an individual duly authorized and having authority
to sign on behalf of, and approve for, SMFD or DHCS, as applicable, and is authorized
and designated to enter into and approve this Agreement on behalf of SMFD or DHCS,
as applicable.
SACRAMENTO METR � ITAN FIRE DISTRICT
Signature: 11 _
Name: Todd Harms
Title: Fire Chief
Date: ae.a-„,%< � /(o, o2di�,
SACRAMENTO MET POLITAN FIRE DISTRICT
Signature:
Name: Amanda Thomas
Title: Chief Financial Officer
Date: pCu.wl, Zp��l(o
CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES
Contract Management Unit
—�
Signature:Name- Dan —��—
Title: ie , on rani—t alG n roent Unit
Date:
CALIFORNIA DEPARTMENT OF GENERAL SERVICES WF'IJHC)VED
Office of Legal Services I FFS
2 3 2011
Signature:
Name:
Title:
Date:
Page 7 of 8
DHCS #16-93420
SCHEDULE A
SCOPE OF WORK
CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES
JULY 1, 2017 - JUNE 30, 2020
DHCS agrees to:
A. Lead the development, implementation, and administration for the Medi -Cal
Ground Emergency Medical Transportation Services (GEMT) supplemental
reimbursement program and ensure compliance with provision set forth in SPA
09-024.
B. Submit claims for federal financial participation (FFP) based on expenditures for
GEMT services that are allowable expenditures under federal law.
C. On an annual basis, submit any necessary materials to the federal government to
provide assurances that claims for FFP will include only those expenditures that
are allowable under federal law.
D. Reconcile certified public expenditure (CPE) invoices with supplemental
reimbursement payments and ensure that the total Medi -Cal reimbursement
provided to eligible GEMT providers will not exceed applicable federal upper
payment limit as described in 42 C.F.R. 447 -Payments For Services.
E. Complete the audit and settlement process of the interim reconciliations for the
claiming period within three years of the postmark date of the cost report and
conduct on-site audits as necessary.
F. Calculate the actual costs for administrative accounting, policy development, and
data processing maintenance activities, including the indirect costs related to the
GEMT supplemental reimbursement program provided by its staff based upon a
cost accounting system which is in accordance with the provisions of Office of
Management and Budget Circular A-87 and 45 Code of Federal Regulations Parts
74 and 95.
G. Maintain accounting records to a level of detail which identifies the actual
expenditures incurred for personnel services which includes salary/wages,
benefits, travel and overhead costs for DHCS' staff, as well as equipment and all
related operating expenses applicable to these positions to include, but not limited
to, general expense, rent and supplies, and travel cost for identified staff and
managerial staff working specifically on activities or assignments directly related
to the GEMT supplemental reimbursement program. Accounting records shall
include continuous time logs for identified staff that record time spent in the
following areas: the GEMT supplemental reimbursement program, general
administration.
H. Ensure that an appropriate audit trail exists within DHCS records and accounting
system and maintain expenditure data as indicated in this Agreement.
Page 8 of 8
DHCS #16-93420
Designate a person to act as liaison with SMFD in regard to issues concerning this
Agreement. This person shall be identified to SMFD's contact person for this
Agreement.
J. Provide a written response by email or mail to SMFD's contact person within thirty
(30) days of receiving a written request for information related to the GEMT
supplemental reimbursement program.
K. Provide accounting, and program technical assistance, and training related to the
GEMT supplemental reimbursement program to SMFD personnel after receiving
a written request from SMFD contact person.
GEMT Provider Participation Agreement
FY 2010/2014
MEDI-CAL GROUND EMERGENCY MEDICAL TRANSPORTATION SERVICES (GEMT)
SUPPLEMENTAL REIMBURSEMENT PROGRAM
PROVIDER PARTICIPATION AGREEMENT
Name of Provider: City of Newport Beach NPI Provided# 1679579296
ARTICLE 1- STATEMENT OF INTENT
The purpose of this Agreement is to allow participation in the Ground Emergency Medical
Transportation Supplemental Reimbursement Program (GEMT program) by the governmentally
owned or operated provider, named above and hereinafter referred to as Provider, subject to
Provider's compliance with the responsibilities set forth in this Agreement with the California
Department of Health Care Services (DHCS), hereinafter referred to as the State or DHCS, as
authorized in State law pursuant to section 14105.94 of the California Welfare and Institutions
Code.
ARTICLE 2- TERM OF AGREEMENT
A. This Agreement begins on January 30, 2010, and stays in effect until this Agreement is
terminated or the GEMT program ends pursuant to the repeal of State or federal statutory
authority to make payments or claim federal reimbursement.
B. Either party may terminate this Agreement, without cause, by delivering written notice of
termination to the other party at least thirty (30) days prior to the effective date of termination.
C. Failure by Provider to comply with Provider's responsibilities under Article 3 shall constitute a
material breach of this Agreement, which shall result in termination by Provider pursuant to
Paragraph B. Provider may prevent the termination of this Agreement pursuant to this
Paragraph by curing any material breach prior to termination of this Agreement, unless actions
giving rise to the material breach result from not complying with Paragraphs K, L, M, or N of
Article 3.
D. Failure by Provider to comply with Provider's responsibilities under Paragraph 0 of Article 3
shall result in an immediate suspension of this Agreement and initiate termination pursuant to
Paragraph B. Upon suspension, the Provider may not participate in the GEMT program,
Provider's claims identified in Article 4 shall not be reimbursed, and DHCS is no longer subject
to its obligations in Article 4. Provider may reverse the suspension and prevent termination by
complying with Paragraph 0 of Article 3 in its entirety.
Page 1 of 11
GEMT Provider Participation Agreement
FY 2010/2014
ARTICLE 3- GEMT PROVIDER RESPONSIBILITIES
By entering into this Agreement, the Provider agrees to:
A. Comply with Title XIX of the Social Security Act, as periodically amended; Titles 42 and 45 of
the Code of Federal Regulations (CFR), as periodically amended; The California Medicaid
State Plan, as periodically amended; Chapter 7 (commencing with Section 14000) of the
California Welfare and Institutions (W&I) Code, as periodically amended; Division 3 of Title 22
of the Califomia Code of Regulations (CCR) (commencing with Section 50000), as periodically
amended; State issued policy directives, including Policy and Procedure Letters, as
periodically amended; and federal Office of Management and Budget (OMB) Circular A-87,as
periodically amended.
B. Ensure all applicable State and federal requirements, as identified in Paragraph A of Article 3,
are met in rendering services under this Agreement. It is understood and agreed that failure
by the Provider to ensure all applicable State and federal requirements are met in rendering
services subject to supplemental reimbursement under this Agreement shall be sufficient
cause for the State to deny or recoup payments to the Provider as well as termination of this
Agreement.
C. Submit an annual participation survey to DHCS by July 1 of each state fiscal year to:
Regular U.S. Postal Service Mail:
Overnight or Express Mail:
Department of Health Care Services Safely
Department of Health Care Services Safely Net
Net Financing, GEMT Program P.O. Box
Financing, GEMT Program
997436, MS 4504
1501 Capitol Ave, MS 4504
Sacramento, CA 95899-7436
Sacramento, CA 95814
D. Comply with the following Expense Allowability and Fiscal Documentation requirements:
1) Provider cost report and claim form that are accepted or submitted for payment by the
Slate shall not be deemed evidence of allowable Agreement costs.
2) Provider shall maintain for review and audit and supply to the State, upon request,
auditable documentation of all amounts claimed pursuant to this Agreement to permit a
determination of expense allowability.
3) If the allowability or appropriateness of an expense cannot be determined by the State
because invoice detail, fiscal records, or backup documentation is nonexistent or
inadequate, according to generally accepted accounting principles or practices, all
questionable costs may be disallowed and payment may be withheld by the State. Upon
Page 2 of 11
GEMT Provider Participation Agreement
FY 2010/2014
receipt of adequate documentation supporting a disallowed or questionable expense,
reimbursement may resume for the amount substantiated and deemed allowable.
E. By November 30 of each year:
1) Submit a signed electronic PDF copy of the annual GEMT Cost Report for the prior fiscal
year ending June 30, to: GEMTSubmissions(d)dhcs.ca.gov
F. Accept payment in full the reimbursement received for services subject to supplemental
reimbursement pursuant to this Agreement.
G. Comply with confidentiality requirements as specified in paragraph (7) of subsection (a) of
section 1396a of Title 42 of the United States Code, 42 CFR 431.300, W&I Code sections
14100.2 and 14132.47, and 22 CCR Section 51009.
H. Submit claims in accordance with 42 CFR 433.51,
I. Retain all necessary records for a minimum of three (3) years after the end of the quarter in
which the provider submitted its cost reports to DHCS. If an audit is in progress, all records
relevant to the audit shall be retained until the completion of the audit or the final resolution of
all audit exceptions, deferrals, and/or disallowances. Records must fully disclose the name
and Medi -Cal number or beneficiary identification code (BIC) of the person receiving the
services, the name of the provider agency and person providing the service, the date and
place of service delivery, and the nature and extent of the service provided. The Provider
shall furnish said records and any other information regarding expenditures and revenues for
providing services, upon request, to the State and to the federal government.
J. Be responsible for the acts or omissions of its employees and/or subcontractors.
K. Comply with the following requirements pertaining to exclusions. The conviction of an
employee or subcontractor of the Provider, or of an employee of a subcontractor, of any felony
or of a misdemeanor involving fraud, abuse of any Medi -Cal beneficiary, or abuse of the Medi -
Cal program, shall result in the exclusion of that employee or subcontractor, or employee of a
subcontractor, from participation in the GEMT Program. Failure to exclude a convicted
individual from participation in the GEMT Program shall constitute a breach of this Agreement.
L. Comply with the following requirements pertaining to exclusions. Exclusion after conviction
shall result regardless of any subsequent order under section 1203.4 of the Penal Code
allowing a person to withdraw his or her plea of guilty and to enter a plea of not guilty, or
setting aside the verdict of guilty, or dismissing the accusation, information, or indictment.
M. Comply with the following requirements pertaining to exclusions. Suspension or exclusion of
Page 3 of 11
GEMT Provider Participation Agreement
FY 2010/2014
an employee or a subcontractor, or of an employee of a subcontractor, from participation in
the Medi -Cal program, the Medicaid program, or the Medicare program, shall result in the
exclusion of that employee or subcontractor, or employee of a subcontractor, from
participation in the GEMT program. Failure to exclude a suspended or excluded individual
from participation in the GEMT program shall constitute a breach of this Agreement.
N. Comply with the following requirements pertaining to exclusions. Revocation, suspension, or
restriction of the license, certificate, or registration of any employee, subcontractor, or
employee of a subcontractor, shall result in exclusion from the GEMT program, when such
license, certificate, or registration is required for the provision of services. Failure to exclude
an individual whose license, certificate, or registration has been revoked, suspended, or
restricted from the provision of services may constitute a breach of this Agreement.
0. Enter into a separate agreement with a host entity in order to satisfy the requirements in
subdivision (d) of section 14105.94 of the W&I Code where the host entity will collect the
payments from Provider in order to pay DHCS for its administrative costs, which are the
costs incurred by DHCS pursuant to its responsibilities described in Article 4. If Provider is the
host entity, then it shall enter into a separate agreement with DHCS to pay the administrative
costs incurred in processing the claims of the GEMT program invoiced through the separate
agreement. If Provider is the host entity and contracts with at least one other provider for
purposes of participating in the GEMT program, then it shall enter into an agreement with
other such providers participating in the GEMT program to collect payments from the other
providers for DHCS's administrative costs incurred in processing the other providers claims
under the GEMT program.
ARTICLE 4- STATE RESPONSIBILITIES
By entering into this Agreement, the State agrees to:
A. Lead the development, implementation, and administration for the GEMT program and ensure
compliance with the provisions set forth in the California Medicaid State Plan.
B. Submit claims for federal financial participation (FFP) based on expenditures for GEMT
services that are allowable expenditures under federal law.
C. On an annual basis, submit any necessary materials to the federal government to provide
assurances that claims for FFP will include only those expenditures that are allowable under
federal law.
D. Reconcile certified public expenditure (CPE) invoices with supplemental reimbursement
payments and ensure that the total Medi -Cal reimbursement provided to eligible GEMT
providers will not exceed applicable federal upper payment limit as described in 42 C.F.R.
Page 4 of 11
GEMT Provider Participation Agreement
447 -Payments For Services.
FY 2010/2014
E. Complete the audit and settlement process of the interim reconciliations for the claiming period
within three (3) years of the postmark date of the cost report and conduct on-site audits as
necessary.
F. Calculate the actual costs for administrative accounting, policy development, and data
processing maintenance activities, including the indirect costs related to the GEMT program
provided by its staff based upon a cost accounting system which is in accordance with the
provisions of Office of Management and Budget Circular A-87 and 45 CFR Parts 74 and 95.
G. Maintain accounting records to a level of detail which identifies the actual expenditures
incurred for personnel services which includes salary/wages, benefits, travel and overhead
costs for Contractor's staff, as well as equipment and all related operating expenses
applicable to these positions to include, but not limited to, general expense, rent and supplies,
and travel cost for identified staff and managerial staff working specifically on activities or
assignments directly related to the GEMT program. Accounting records shall include
continuous time logs for identified staff that record time spent in the following areas: the GEMT
program, general administration.
H. Ensure that an appropriate audit trail exists within Contractor records and accounting system
and maintain expenditure data as indicated in this Agreement.
I. Designate a person to act as liaison with Provider in regard to issues concerning this
Agreement. This person shall be identified to Provider's contact person for this Agreement.
J. Provide a written response by email or mail to Provider's contact person within thirty (30) days
of receiving a written request for information related to the GEMT program.
K. Provide program technical assistance and training related to the GEMT program to provider
personnel after receiving a written request from Provider contact person.
ARTICLE 5 -PROJECT REPRESENTATIVES
A. the
Name: Faye Borton
Unit: Quality Assurance Fee
Telephone: (916) 552-9113
Fax: (916) 552-8651
Email: G EMT@dhcs.ca.00v
curing the term OT inis Ngreernem will ue:
e Services I Provider
City of Newport Beach
Telephone: (949)644-3106
Fax(949)644-3120
Email: sposter@nbfd.net
Page 5 of 11
GEMT Provider Participation Agreement
B. Direct all inquiries to:
FY 2010/2014
Department of Health Care Services Provider: City of Newport Beach
Section: Medi -Cal Supplemental Payments Telephone: (949) 644-3106
Unit: Quality Assurance Fee Fax: (949) 644-3120
Attention: Email: sposter@nbfd.net
GEMT Supplemental Reimbursement Program
Address: 1501 Capitol Avenue, MS 4504
P.O. Box 997436
Sacramento, CA 95899-7436
Telephone: (916) 552-9113
Fax: (916) 552-8651
Email: GEMT@dhcs.ca.gov
C. Either party may make changes to the information above by giving written notice to the other
party. Said changes shall not require an amendment to this agreement.
ARTICLE 6• GENERAL PROVISIONS
A. This document constitutes the entire Agreement between the parties. Any condition,
provision, agreement or understanding not stated in this Agreement shall not affect any rights,
duties, or privileges in connection with this Agreement.
B. The term "days" as used in this Agreement shall mean calendar days unless specified
otherwise.
C. The State shall have the right to access, examine, monitor, and audit all records, documents,
conditions, and activities of the Provider and its subcontractor related to the services provided
pursuant to this Agreement.
D. No covenant, condition, duty, obligation, or undertaking made a part of this Agreement shall
be waived except by amendment of the Agreement by the parties hereto, and forbearance or
indulgence in any other form or manner by either party in any regard whatsoever shall not
constitute a waiver of the covenant, condition, duty, obligation, or undertaking to be kept,
performed, or discharged by the party to which the same may apply; and, until performance or
satisfaction of all covenants, duties, obligations, or undertakings is complete, the other party
shall have the right to invoke any remedy available under this Agreement, or under law,
notwithstanding such forbearance or indulgence.
E. None of the provisions of this Agreement are or shall be construed as for the benefit of, or
enforceable by, any person not a party to this Agreement.
Page 6 of 11
GEMT Provider Participation Agreement FY 2010/2014
ARTICLE 7 -AMENDMENT PROCESS
A. Should either party, during the term of this Agreement, desire a change or amendment to the
terms of this Agreement, such changes or amendments shall be proposed in writing to the
other party, who will respond in writing as to whether the proposed amendments are accepted
or rejected. If accepted and after negotiations are concluded, the agreed upon changes shall
be made through a process that is mutually agreeable to both the State and the Provider. No
amendment will be considered binding on either party until it is approved in writing by both
parties. Replacing the Project Representative does not require an amendment to this
agreement and may be updated with written notice sent to the other party. Written notice may
include email.
ARTICLE 8- AVOIDANCE OF CONFLICTS OF INTEREST BY THE PROVIDER
A. The State intends to avoid any real or apparent conflict of interest on the part of the Provider,
subcontractors, or employees, officers, and directors of the Provider or subcontractors. Thus,
the State reserves the right to determine, at its sole discretion, whether any information,
assertion, or claim received from any source indicates the existence of a real or apparent
conflict of interest; and, if a conflict is found to exist, to require the Provider to submit
additional information or a plan for resolving the conflict, subject to the State's review and prior
approval.
B. Conflicts of interest include, but are not limited to:
1) An instance where the Provider or any of its subcontractors, or any employee, officer, or
director of the Provider or any subcontractor has an interest, financial or otherwise,
whereby the use or disclosure of information obtained while performing services under the
contract would allow for private or personal benefit or for any purpose that is contrary to
the goals and objectives of the contract.
2) An instance where the Provider's or any subcontractor's employees, officers, or directors
use their positions for purposes that are, or give the appearance of being, motivated by a
desire for private gain for themselves or others, such as those with whom they have family,
business or other ties.
C. If the State is or becomes aware of a known or suspected conflict of interest, the Provider will
be given an opportunity to submit additional information or to resolve the conflict. A Provider
with a suspected conflict of interest will have five (5) working days from the date of notification
of the conflict by the State to provide complete information regarding the suspected conflict. If
a conflict of interest is determined to exist by the State and cannot be resolved to the
satisfaction of the State, the conflict will be grounds for terminating the contract. The State
may, at its discretion upon receipt of a written request from the Provider, authorize an
extension of the timeline indicated herein.
Page 7 of 11
GEMT Provider Participation Agreement FY 2010/2014
ARTICLE 9 - FISCAL PROVISIONS
Reimbursement under this Agreement shall be made in the following manner:
A. Upon the Provider's compliance with all provisions pursuant to W&I Code section14105.94
and this Agreement, and upon the submission of a cost report and claim form based on valid
and substantiated information, the State agrees to process the cost report and claim form for
reimbursement.
B. Transfer of funds is contingent upon the availability of federal financial participation. If, in the
event federal financial participation funds for a service period are not available for all of the
supplemental amounts payable to GEMT providers due to the application of a federal limit or
for any other reason, both of the following shall apply:
1) The total amounts payable to GEMT providers for the service period shall be reduced to
reflect the amounts for which federal financial participation is available.
2) The amounts payable to each GEMT provider for the service period shall be equal to the
amounts computed under Article 3 multiplied by the ratio of the total amounts for which
federal financial participation is available.
C. Provider shall certify the certified public expenditure from the Provider's General Fund, or from
any other funds allowed under federal law and regulation, for Title XIX funds claimed for
reimbursement pursuant to W&I Code section 14105.94. The State shall deny payment of any
invoice submitted under this Agreement, If it determines that the certification is not adequately
supported for purposes of FFP. The following certification statement shall be made on each
Summary Invoice submitted to the State for payment for the performance of services:
"I, certify under penalty of perjury as follows: Public funds for services provided have been
expended as necessary for federal financial participation, pursuant to the requirements of Section
1903(w) of the Social Security Act and 42 C.F.R. § 433.50, et seq. for allowable costs. The
expenditures claimed have not previously been, nor will be, claimed at any other time to receive
federal funds under Medicaid or any other program. The provider acknowledges that the
information is to be used for claiming federal funds and understands that misrepresentation of
information constitutes a violation of federal and State law. The provider acknowledges that all
funds expended pursuant to W&I Code section 14105.94 are subject to review and audit by the
Department of Health Care Services. The provider acknowledges that it understands that DHCS
must deny payments for any claim submitted under W&I Code section 14105.94, if it determines
that the certification is not adequately supported for purposes of federal financial participation. That
I am the responsible person of the subject fire department I agency and am duly authorized to sign
this certification and that, to the best of my knowledge and information, each statement and amount
in the accompanying schedules are to be true, correct, and In compliance with section 14105.94
of the California Welfare and Institutions Code."
Page 8 of 11
GEMT Provider Participation Agreement
FY 2010/2014
ARTICLE 10- RECOVERY OF OVERPAYMENTS
A. Provider agrees that when it is established upon audit that an overpayment has been made,
the Department shall recover such overpayment in accordance with section 51047 of Title 22
of the California Code of Regulations.
B. The State reserves the right to select the method to be employed for the recovery of an
overpayment.
C. Overpayments may be assessed interest charges, and may be assessed penalties, in
accordance with W&I Code Sections 14171(h) and 14171.5.
ARTICLE 11 - BUDGET CONTINGENCY CLAUSE
A. It is mutually agreed that if the State Budget Act of the current year and/or any subsequent
years covered under this Agreement does not appropriate sufficient funds for the GEMT
program, this Agreement shall be of no further force and effect. In this event, the Slate shall
have no liability to pay any funds whatsoever to Provider or to furnish any other considerations
under this Agreement and Provider shall not be obligated to perform any provisions of this
Agreement.
B. If funding for any state fiscal year is reduced or deleted by the State Budget Act for purposes
of this GEMT program, the State shall have the option to either cancel this Agreement, with no
liability occurring to the State, or offer an agreement amendment to Provider to reflect the
reduced amount.
ARTICLE 12- LIMITATION OF STATE LIABILITY
A. Notwithstanding any other provision of this Agreement, the State shall be held harmless from
any federal audit disallowance and interest resulting from payments made by the federal
Medicaid program as reimbursement for claims providing services pursuant to W&I Code
section 14105.94, for the disallowed claim, less the amounts already remitted to the State
pursuant to W&I Code section 14105.94.
B. To the extent that a federal audit disallowance and interest results from a claim or claims for
which the Provider has received reimbursement for services, the State shall recoup from the
Provider, upon written notice, amounts equal to the amount of the disallowance and interest in
that fiscal year for the disallowed claim. All subsequent claims submitted to the State
applicable to any previously disallowed claim, may be held in abeyance, with no payment
made, until the federal disallowance issue is resolved, less the amounts already remitted to
the State pursuant to W&I Code section 14105.94.
Page 9 of 11
ARTICLE 13- AGREEMENT EXECUTION
The undersigned hereby warrants that s/he has the requisite authority to enter into this Agreement on behalf
of Newport Beach Fire Department and thereby bind the above named provider to the terms and conditions
of the same.
Provider Authorized Repr ignature
Print Name
Title NEWPORT BEACH FIRE DEPARTMENT
P,O. BOX 1768
NEWPORT BEACH, CA 92658.8915
Address
SEP 2 7 2013
De --bDe of ealth afe Services
Authorized Representative's Signature
Stacy Fox
Print Name
_ Chief, Medi -Cal Supplemental Payments Section
Title
Name of Department
Address
CA Dept. of Health Care Services
1501 Capitol Avenue, MS 4504
Sacramento, CA 95814
I0 -IS -13
Date
Page it of 11
IN WITNESS WHEREOF, the parties have caused this Agreement to be
executed on the dates written below.
APPROVED ASE TO FORM:
Date:CITY,(i1l%71�� `jY'S OFFICE
//it11/Rry►!/
r H; p
City Attorney
ATTEST: Q �/t J
Date: I U
By:-MqLeilani rown
City Clerk
a
CITY OF NEWPORT BEACH,
A California municipal corporation
Date: ogLi1u ,
By: � �"l N
Dave iff —
City Manager
[END OF SIGNATURES]