HomeMy WebLinkAboutC-8085-3E - Intergovernmental Agreement Regarding Transfer of Public Funds 2020 #19-96392CONTRACT #19-96392
INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES ("DHCS") and the CITY OF NEWPORT BEACH
(GOVERNMENTAL FUNDING ENTITY) with respect to the matters set forth below.
The parties agree as follows:
AGREEMENT
1. Transfer of Public Funds
1.1 The GOVERNMENTAL FUNDING ENTITY agrees to make a transfer
of funds to DHCS pursuant to sections 14164 and 14301.4 of the Welfare and Institutions Code.
The amount transferred shall be based on the sum of the applicable rate category per member per
month (PMPM) contribution increments multiplied by member months, as reflected in Exhibit 1.
The GOVERNMENTAL FUNDING ENTITY agrees to initially transfer amounts that are
calculated using the Estimated Member Months in Exhibit 1, which will be reconciled to actual
enrollment for the service periods of July 1, 2019 through June 30, 2020, and July 1, 2020
through December 31, 2020, and reconciled to actual PMPMs for the service period of July 1,
2020 through December 31, 2020 in accordance with Sub -Section 1.3 of this Agreement. The
funds transferred shall be used as described in Sub -Section 2.2 of this Agreement. The funds
shall be transferred in accordance with the terms and conditions, including schedule and amount,
established by DHCS.
1.2 The GOVERNMENTAL FUNDING ENTITY shall certify that the funds
transferred qualify for Federal Financial Participation pursuant to 42 C.F.R. part 433, subpart B,
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and are not derived from impermissible sources such as recycled Medicaid payments, Federal
money excluded from use as State match, impermissible taxes, and non -bona fide provider -
related donations. Impermissible sources do not include patient care or other revenue received
from programs such as Medicare or Medicaid to the extent that the program revenue is not
obligated to the State as the source of funding.
1.3 DHCS shall reconcile the "Estimated Member Months," in Exhibit 1, to
actual enrollment in HEALTH PLAN(S) for the service periods of July 1, 2019 through June 30,
2020, and July 1, 2020 through December 31, 2020 using actual enrollment figures taken from
DHCS records. Enrollment reconciliation will occur on an ongoing basis as updated enrollment
figures become available. Actual enrollment figures will be considered final two years after
June 30, 2020 and December 31, 2020, respectively. DHCS shall reconcile the "Projected
Contribution PMPM," in Exhibit 1(b), to actual PMPM for HEALTH PLAN(S) for the service
period of July 1, 2020 through December 31, 2020 using actual PMPMs that result from the risk
adjustment process as reflected in figures taken from DHCS records. PMPM reconciliation will
occur on an ongoing basis as the risk adjustment process is finalized. Actual PMPM amounts
will be considered final two years after December 31, 2020. If reconciliation results in an
increase to the total amount necessary to fund the nonfederal share of the payments described in
Sub -Section 2.2, the GOVERNMENTAL FUNDING ENTITY agrees to transfer any additional
funds necessary to cover the difference. If reconciliation results in a decrease to the total amount
necessary to fund the nonfederal share of the payments described in Sub -Section 2.2, DHCS
agrees to return the unexpended funds to the GOVERNMENTAL FUNDING ENTITY. If
DHCS and the GOVERNMENTAL FUNDING ENTITY mutually agree, amounts due to or
owed by the GOVERNMENTAL FUNDING ENTITY may be offset against future transfers.
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2. Acceptance and Use of Transferred Funds
2.1 DHCS shall exercise its authority under section 14164 of the Welfare and
Institutions Code to accept funds transferred by the GOVERNMENTAL FUNDING ENTITY
pursuant to this Agreement as IGTs, to use for the purpose set forth in Sub -Section 2.2.
2.2 The funds transferred by the GOVERNMENTAL FUNDING ENTITY
pursuant to Section 1 and Exhibit 1 of this Agreement shall be used to fund the non-federal share
of Medi -Cal Managed Care actuarially sound capitation rates described in section 14301.4(b)(4)
of the Welfare and Institutions Code as reflected in the contribution PMPM and rate categories
reflected in Exhibit I. The funds transferred shall be paid, together with the related Federal
Financial Participation, by DHCS to HEALTH PLAN(S) as part of HEALTH PLAN(S)'
capitation rates for the service periods of July 1, 2019 through June 30, 2020, and July 1, 2020
through December 31, 2020, in accordance with section 14301.4 of the Welfare and Institutions
Code.
2.3 DHCS shall seek Federal Financial Participation for the capitation rates
specified in Sub -Section 2.2 to the full extent permitted by federal law.
2.4 The parties acknowledge that DHCS will obtain any necessary approvals
from the Centers for Medicare and Medicaid Services.
2.5 DHCS shall not direct HEALTH PLAN(S)' expenditure of the payments
received pursuant to Sub -Section 2.2.
Assessment Fee
3.1 DHCS shall exercise its authority under section 14301.4 of the Welfare
and Institutions Code to assess a 20 percent fee related to the amounts transferred pursuant to
Section 1 of this Agreement, except as provided in Sub -Section 3.2. GOVERNMENTAL
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FUNDING ENTITY agrees to pay the full amount of that assessment in addition to the funds
transferred pursuant to Section 1 of this Agreement.
3.2 The 20 -percent assessment fee shall not be applied to any portion of funds
transferred pursuant to Section 1 that are exempt in accordance with sections 14301.4(d) or
14301.5(b)(4) of the Welfare and Institutions Code. DHCS shall have sole discretion to
determine the amount of the funds transferred pursuant to Section 1 that will not be subject to a
20 percent fee. DHCS has determined that $0.00 of the transfer amounts will not be assessed a
20 percent fee, subject to Sub -Section 3.3.
3.3 The 20 -percent assessment fee pursuant to this Agreement is non-
refundable and shall be wired to DHCS separately from, and simultaneous to, the transfer
amounts made under Section 1 of this Agreement. If, at the time of the reconciliation performed
pursuant to Sub -Section 1.3 of this Agreement, there is a change in the amount transferred that is
subject to the 20 -percent assessment in accordance with Sub -Section 3. 1, then a proportional
adjustment to the assessment fee will be made.
4. Amendments
4.1 No amendment or modification to this Agreement shall be binding on
either party unless made in writing and executed by both parties.
4.2 The parties shall negotiate in good faith to amend this Agreement as
necessary and appropriate to implement the requirements set forth in Section 2 of this
Agreement.
5. Notices. Any and all notices required, permitted or desired to be given hereunder
by one party to the other shall be in writing and shall be delivered to the other party personally or
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by United States First Class, Certified or Registered mail with postage prepaid, addressed to the
other party at the address set forth below:
To the GOVERNMENTAL FUNDING ENTITY:
Mary Locey, Administrative Manager
City of Newport Beach Fire Department
100 Civic Center Drive
Newport Beach, CA 92660
mloceyna,nbfd.net
With copies to:
City Attorney
City of Newport Beach
100 Civic Center Drive
Newport Beach, CA 92660
hnichols@newportbeachea.gov
Sandra Dixon
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., Suite 71-4002
MS 4413
Sacramento, CA 95814
Sandra. Dixonkdhcs.ca. Dov
6. Other Provisions
6.1 This Agreement contains the entire Agreement between the parties with
respect to the Medi -Cal payments described in Sub -Section 2.2 of this Agreement that are funded
by the GOVERNMENTAL FUNDING ENTITY, and supersedes any previous or
contemporaneous oral or written proposals, statements, discussions, negotiations or other
agreements between the GOVERNMENTAL FUNDING ENTITY and DHCS relating to the
subject matter of this Agreement. This Agreement is not, however, intended to be the sole
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agreement between the parties on matters relating to the funding and administration of the Medi -
Cal program. This Agreement shall not modify the terms of any other agreement, existing or
entered into in the future, between the parties.
6.2 The non -enforcement or other waiver of any provision of this Agreement
shall not be construed as a continuing waiver or as a waiver of any other provision of this
Agreement.
6.3 Sections 2 and 3 of this Agreement shall survive the expiration or
termination of this Agreement.
6.4 Nothing in this Agreement is intended to confer any rights or remedies on
any third party, including, without limitation, any provider(s) or groups of providers, or any right
to medical services for any individual(s) or groups of individuals. Accordingly, there shall be no
third party beneficiary of this Agreement.
6.5 Time is of the essence in this Agreement.
6.6 Each party hereby represents that the person(s) executing this Agreement
on its behalf is duly authorized to do so.
State Authority. Except as expressly provided herein, nothing in this Agreement
shall be construed to limit, restrict, or modify the DHCS' powers, authorities, and duties under
Federal and State law and regulations.
8. Approval. This Agreement is of no force and effect until signed by the parties.
9. Term. This Agreement shall be effective as of July t, 2019 and shall expire as of
June 30, 2023 unless terminated earlier by mutual agreement of the parties.
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CONTRACT 919-96392
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on
the date of the last signature below.
THE CITY OF NEWPORT BEACH:
By: y/Uf/ C- %iGG Date: �gt/0?c3
Will O'Neill, Mayor
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: r i/ (:il Date: 102./8/',"d
Rafael Davtian, Division Chief, Capitated Rates Development Division
:PPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Date: 4 / oil 2-n ZO
By: �� �j,,1ti"'
Aaron C. Harp, City Attorney (Ni*d-oo4rw
Attest:
,0--Leilani I. Brown, MMC, City Clerk
Date: 9=30 -W 1
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CONTRACT #19-96392
Exhibit 1
Health Plan:
CalOptima
Rating Region:
Orange
Service Period
7/2019-12/2019
Rate Category
Contribution PMPM
Estimated Member
Months*
Contribution
Estimated
(Non -
Federal Share)
Child - non MCHIP
$
0.02
1,111,946
$
22,239
Chill - MCHIP
$
0.01
593,412
$
5,934
Adult - non MCI -EP (non -CCI)
$
0.07
499,192
$
34,943
Adult - MCHIP (non -CCI)
$
0.03
14,171
$
425
ACA Optional Expansion
$
0.01
1,361,925
$
13,619
SPD
$
0.16
225,732
$
36,117
SPD/Full-Dual (non -CCI)
$
0.04
10,214
$
409
BCCTP
$
0.38
3,250
$
1,235
LTC
$
1.04
8,185
$
8,512
Whole Child Model
$
0.40
70,220
$
28,088
Estimated Total
3,898,247
$
151,521
Health Plan:
CalOptima
Rating Region:
Orange
Rating Region:
1/2020-6/2020
Rate Category
Contribution PMPM
Estimated Member
Months*
Estimated
Contribution (Non -
Federal Share)
Child - non MCHIP
$
0.02
1,11.9,21.2
$
22,384
Child - MCHIP
$
0.01
597,290
$
5,973
Adult - non MCFIIP (non -CCI)
$
0.06
498,784
$
29,927
Adult -MCFIIP (non -CCI)
$
0.03
14,159
$
425
ACA Optional Expansion
$
0.01
1,381,635
$
13,816
SPD
$
0.14
227,732
$
31,882
SPD/Full-Dual (non -CCI)
$
0.03
8,366
$
251
BCCTP
$
0.37
3,315
$
1,227
LTC
$
0.93
8,663
$
8,057
Whole Child Model
$
0.36
69,802
$
25,129
Estimated Total
3,928,958
$
139,071
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Exhibit 1(b)
Health Plan:
CalOptima
Rating Region:
Orange
Rating Region:
7/2020 -12/2020
Rate Category
Projected
Contribution
PMPM**
Estimated Member
Months*
Estimated
Contribution (Non -
Federal Share)
Chill - non WHIP
$ 0.02
1,229,666
$ 24,593
Chill - MCHIP
$ 0.02
656,235
$ 13,125
Adult - non MCHIP (non -CCI)
$ 0.07
552,474
$ 38,673
Adult - MCHIP (non -CCI)
$ 0.04
15,684
$ 627
ACA Optional Expansion
$ 0.01
1,560,105
$ 15,601
SPD
$ 0.15
237,276
$ 35,591
SPD/Fuff-Dual (non -CCI)
$ 0.03
8,769
$ 263
BCCTP
$ 0.37
3,693
$ 1,366
LTC
$ 0.95
9,111
$ 8,655
Whole Child Model
$ 0.39
74,690
$ 29,129
Estimated Total
4,347,703
$ 167,623
* Note that Estimated Member Months are subject to variation, and the actual total Contribution
(Non -Federal Share) may differ from the amount listed here.
** Note that Projected Contribution PMPMs are subject to change based on the risk adjustment
process of rate development, and the actual total Contribution (Non -Federal Share) may differ
from the amount listed here.
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