RESOLUTION NO. 18— 2015
RESOLUTION OF THECITYCOUNCIL OF THE
CITY OF SONOMA AUTHORIZING THE
CITY MANAGER TO EXECUTE ANAGREEMENT FOR INTERGOVERNMENTALTRANSFER
WITH PARTNERSHIP HEALTHPLAN
OF CALIFORNIA
WHEREAS, since 2006, the California Department of Health Care Services (DHCS) has offered local governments that provide health care the opportunity to secure additional Medi-Cal
revenues by participating in a voluntary Intergovernmental Transfer (IGT) program with their local Medi-Cal managed care plan; and
WHEREAS, Partnership HealthPlan of California (PHC), is a nonprofit community-based healthcare organization that contracts with the State to administer additional Medi-Cal revenues to public ambulance providers (i.e., Sonoma Fire Department) to offset previously unreimbursed costs for serving Medi-Cal plan members; and
WHEREAS, Partnership HealthP|an of California covers members who currently make
up approximately 80% of HMO-managed Medi-Cal patients and, although the City incurs significant costs for these types of ambulance transports, itcan onlycontractually bill and expect payment for a certain amount (i.e., a fixed rate of approximately $150 is received per Medi-Cal patient whiles costs incurred equal approximately $1,200 per patient); and
WHEREAS, participation in an Intergovernmental Transfer Program represents an
opportunity for localgovernment providers of Medi-Cal services to re-coup a share of their costs for serving PHC patients, most notably because Californiatends to pay Plans at the lower end of the actuarially sound rate range and the Federal government, tapping potentially unclaimed
Federal matches, works to make up the difference by requiring all managed care Plans to be paid at an actuarially sound rate; and
WHEREAS, an lGT program of this type is a matching program, not a reimbursement program and, therefore, the Federal government willmatch the transferred funds, pay half of the Plan's rate increases and, inthe end, the local entity receives its own funding plus the Federal match in return; and
WHEREAS, PHC’s role is to collect and submitdata to DHCS on each entity interested
in participating in the IGT and to assist each participating entity with the terms governing the Program and use of newly received revenue; and
WHEREAS, PHC, as the agent for DHCS, has determined that the City of Sonoma shall transfer funds equal to $104,921 to DHCS pursuant to section 14164 and 14301.4 of the
while the total amount of PHC’s payment back to the provider is considered Medi-Calrevenue and must be used for health care services, the funds do not need to be Medi—Calservices provided exclusively to Medi-Cal patients and funds do not have to be expended in the year received.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Sonoma, as
follows:
1. The proposed agreement with the California Department of Health Care Services
(DHCS) for Intergovernmental Transfer (lGT) in order to increase Medi-Cal
reimbursement for EMS ambulance transport services previously provided to
Partnership Health Plan's members in FY2013-14 and which willresult in transfer of local matchable funds to the State inthe summer of 2015, attached to this resolutionas Exhibit A, is hereby approved and the City Manager is authorized to sign the agreement on behalf ofthe City.
2. The proposed agreement with the California Department of Health Care Services (DHCS) for Intergovernmental Transfer Assessment Fee willresult in payment of a 20%
fee to DHCS which is a condition of participating inthe IGT, attached to this resolution
as Exhibit B, is hereby approved and the City Manager is ‘authorized to sign the agreement on behalf of the City.
PASSED, APPROVED ANDADOPTED this 1st day of June 2015 by the following vote: AYES: Edwards, Gallian, Cook, Hundley, Agrimonti
NOES: None M‘ ABSENT: None *’
E,
f/‘
‘i
r’David Cook, Mayor ATTEST:
Gay
Joh:%
Exhibit A INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement is enteredintobetweentheCALIFORNIA DEPARTMENT OF HEALTH CARE
SERVICES (“DHCS”) and the CITY OF SONOMA withrespect to thematters set forthbelow.
RECITALS
A. This Agreement ismadepursuant to the authority of Welfare &Institutions Code,section
14164and14301.4.
B. The Partnership HealthPlanofCalifornia isaCounty Organized HealthSystem formed
pursuant to Welfare andInstitutions Code section14087.54 andCounty Code Chapter 7.58,County Code Chapter 2.45, County Code Chapter 2, Title2, andCounty Code Chapter 34. PartnershipHealthPlanof California isa party to a Medi-Cal managed care contract withDHCS, entered intopursuant to Welfare andInstitutionsCode section 14087.3,underwhich Partnership Hea1thPlan of California arranges and
pays for theprovisionof coveredMedi-Cal healthcare servicesto eligible Medi-Cal members residing in theCounty.
THEREFORE, the parties agree as follows:
AGREEMENT 1. Transfer of Public Funds
1.1 The CITY OF SONOMA shall transfer funds to DHCS pursuant to section14164 and 14301.4 of the Welfare andInstitutions Code,upto amaximumtotalamount of ONE HUNDRED I
THIRTEEN THOUSAND, SEVEN HUNDRED FORTY-SIX DOLLARS ($113,746), to beusedsolely
as aportion of the nonfederal shareof actuariallysoundMedi-Cal managed care capitationrate increases
forPartnershipI-Iea1thPlanof California for theperiodJuly 1,2013 through June 30, 2014 as describedin
section 2.2 below. The funds shallbe transferred inaccordancewithamutually agreedupon schedule between the CITY OF SONOMA and DHCS, intheamounts speci?ed therein.
1.2 TheCITY OF SONOMA shallcertify that the funds transferred qualify for federal
?nancial participation pursuant to 42C.F.R. part 433 subpart B, andare not derived from
impermissible
sources suchas recycledMedicaidpayments, federal money excludedfromuse as Statematch,
impermissibletaxes, and non—bona?de provider—relateddonations. For transferring unitsof government
thatare also direct service providers, impermissiblesources donot include patient care or otherrevenue
received from programs suchas Medicareor Medicaidto theextent thatthe program revenue isnot
obligatedto theState asthe
source
of funding.2. Acceptance and Useof Transferred Fundsby DHCS
2.1 DHCS shall exercise its authority under section 14164 ofthe Welfare and
InstitutionsCodeto accept funds transferred by the CITY OF SONOMApursuant to this Agreement as
intergovernmental transfers
(“IGTS”),
to use forthepurpose set forth in section2.2below.2.2 The funds transferred by theCITY OF SONOMA pursuant to this Agreement shall
be usedto fund aportion of the nonfederal share of increases in Medi-Cal managed care actuarially sound
capitationrates described in paragraph (4)of subdivision(b) ofsection14301.4 ofthe Welfare and
InstitutionsCode and shall be paid, together with the related federal ?nancial participation, by DHCS to
Partnership Hea1thPlanof California as part of Partnership HealthPlan of Califomia’s capitationrates for
theperiod July 1,2013 through June 30, 2014. Therate increases paid under section 2.2shall beused for
payments relatedto Medi—Calservicesrenderedto Medi-Cal bene?ciaries. Therate increases paid under this section2.2 shall be in additionto, andshallnot replaceor supplant, all otheramounts paidorpayable by DHCS or other State agenciesto PartnershipHea1thPlanof California.
2.3 DHCS shall seekfederal ?nancial participation fortherate increases speci?ed in
section2.2to the fullextent permitted by federal law.
2.4 The parties acknowledge theState DHCS willobtainany necessary approvals fromtheCenters forMedicare andMedicaidServices priorto thepayment ofany rate increasepursuant
to section2.2.
2.5 The partiesagree thatnone ofthesefunds, eitherCITY OF SONOMA or federal matching funds will be recycled backto the City of Sonoma’s general fund, the State,or any other intermediaryorganization. Payments made by the health planto providersundertheterms ofthis
Agreement and theirprovideragreement constitutepatientcare revenues.
2.6 WithinOne HundredTwenty (120) calendardays oftheexecution ofthis
Agreement, DHCS shalladvisethe CITY OF SONOMA andPartnership HealthPlanofCalifornia of the
amount ofthe Medi-Cal managed care capitationrate increases thatDHCS paidto Partnership HealthPlan of California during theapplicablerate year involving any funding under theterms ofthis Agreement.
2.7 If any portion of the funds transferred by the CITY OF SONOMA pursuant to this Agreement is
not
expended forthespeci?ed rate increasesunderSection 2.2, DHCS shallreturn the unexpendedfunds to the CITY OF SONOMA.3. Amendments
3.1 No amendmentormodification to thisAgreement shallbe bindingon eitherparty
unless made in writing andexecutedby both parties.
3.2 The parties shall negotiate in good faithto amendthis Agreement as necessary and
appropriateto implement therequirements set forth insection2 ofthis Agreement.
4.
.
Any andall notices required, permittedor desiredto be givenhereunderbyone party to theothershall be in writing andshall bedeliveredto the otherparty personallyor byUnitedStates first class, certi?ed or registered mail withpostage prepaid,addressedto the otherparty at the
addressset forthbelow:
To theCITY OF SONOMA:
Carol Giovanatto, CityManager City of Sonoma
#1 ThePlaza
Sonoma, CA 95476
Withcopiesto:
Mark Freeman, Fire Chief
Sonoma Valley Fire &Rescue Authority
630
2"“
Street WestSonoma, CA 95476-6901
To DHCS:
Sandra Dixon
California Department of Health Care Services
CapitatedRates Development Division 1501Capitol Ave., Suite 71-4002
MS 4413
Sacramento, CA 95814
5. Other Provisions
5.1 ThisAgreement contains the entire Agreement betweenthe partieswithrespect to
I
the Medi-Calrate increases for Partnership HealthPlan of California described insection2.2thatare
funded by the CITY OF SONOMA andsupersedesanyprevious or
contemporaneous
oralor writtenproposals,statements, discussions, negotiationsor otheragreements betweenthe CITY OF SONOMA andDHCS. This Agreement isnot, however, intendedto be the soleagreement between the partieson matters relating to the funding andadministrationofthe Medi-Calprogram. One or more other
agreements already exist between the parties regarding such othermatters, andotheragreements may be
enteredinto in the future. ThisAgreement shallnot modify theterms of any otheragreement between the parties.
5.2 The nonenforcement or other waiver ofany provision of this Agreement shallnot
be construedas a continuing waiver or as awaiver ofany otherprovision ofthisAgreement.
5.3 Section2 ofthisAgreement shall survivetheexpiration or terminationofthis
Agreement.
5.4 Nothing inthisAgreement is intendedto confer any rights orremedieson anythird
party, including, withoutlimitation,any provider(s)or groups of providers, or any rightto medical services forany individual(s) or groups ofindividuals;accordingly, there shall beno thirdparty
bene?ciary of this Agreement.
5.5 Time is of theessence in this Agreement.
5.6 Eachparty herebyrepresents thatthe person(s) executing thisAgreement on its behalf is dulyauthorizedto doso.
6. State Authority. Except as expresslyprovided herein, nothing in this Agreement shall be
construedto limit, restrict, ormodify the DHCS’ powers, authorities,anddutiesunderfederal andstate
law and regulations.
7. Approval. This Agreement is ofno force and effect until signed bytheparties.
8. Term. This Agreement shallbeeffective as ofJuly 1, 2013 and shall expireas of June 30, 2016unless terminated earlierbymutualagreement ofthe parties.
SIGNATURES
IN WITNESS WHEREOF, the paities hereto have executed this Agreement, on the date of the last signature below.
CITY OF SONOMA
By: Date:
Carol Giovanatto, CityManager
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date:
MeredithWurden, Assistant Deputy Director, Health Care Financing
Exhibit B INTERGOVERNMENTAL TRANSFER ASSESSMENT FEE
This Agreement isenteredinto betweentheCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (“State DHCS”) and the CITY OF SONOMA withrespect to thematters set forth below.
RECITALS
A. This Agreement is madepursuant to the authority of Welfare &Institutions Code, section 14301.4.
THEREFORE, thepartiesagree as follows:
AGREEMENT 1. Transfer of Public Funds
1.1 CITY OF SONOMA shall makeIntergovernmental Transfer(s) (“IGTS”)to State
DHCS pursuant to section 14164 of the Welfare andInstitutionsCode andparagraph 1.1 ofthe
Intergovernmental Agreement(s) Regarding the Transfer of Public Fundscontract number 13-90530,to be
usedas a portion of the non-federal share of actuariallysoundMedi-Cal managed care rate range
capitation increases (“non-federal shareIGT”) to Partnership HealthPlan of California (“PHC”) for the
periodof July 1,2013 through June 30,2014.
1.2 Thepartiesacknowledge that State DHCS will obtainany necessary approvals from the Centers for MedicareandMedicaidServices (“CMS”) pertainingto theacceptance of
non-federal shareIGTs and thepayment of non-federal shareIGT relatedrate range capitation increases
to PHC.
2. Intergovernmental Transfer Assessment Fee
2.1 The State DHCS shall, upon acceptance ofnon-federal share IGTs pursuant to the Intergovernmental Agreement(s)Regarding the Transfer of Public Funds,andas described in paragraph 1 ofthis Agreement, exercise its authority under section 14301.4 of the Welfare andInstitutionsCodeto assess a20-percent assessment feeon theentireamount ofthe non-federal shareIGTs to reimburse State
DHCS forthe administrativecosts of operating the IGTprogram pursuant to this sectionandforthe
support ofthe Medi-Calprogram.
2.2 The funds subjectto the 20-percent assessment fee shallbe limitedto non—federal share IGTs made bythetransferring entity, CITY OF SONOMA,pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of PublicFunds, andas described in paragraph 1ofthis Agreement.
2.3 The 20-percent fee will beassessedon theentireamount ofthe non—federalshare
IGTs pursuant to the Intergovernmental Agreement(s) Regarding the Transfer of Public Funds, andas
describedin paragraph l of this Agreement, andwill bemade inadditionto, and transferred separately
from, the transfer of funds pursuant to theIntergovernmentalAgreement(s) Regarding the Transfer of Public Funds.
2.4 The 20-percent assessment feepursuant to this Agreement is non-refundable and
shallbe wiredto State DHCS separately from, andsimultaneousto,the non-federal shareIGTs pursuant
to theIntergovernmentalAgreement(s) Regarding the Transfer of PublicFunds,andas describedin
paragraph1 ofthisAgreement. However, ifanyportionofthe non—federalshare IGTs isnot expendedfor thespeci?edrate increases statedinparagraph2.2 of the Intergovernmental Agreement(s) Regarding the
Transfer of Public Funds, DHCS shallreturn aproportionateamount ofthe 20-percent assessment fee to
CITY OF SONOMA.
3. Other Provisions
3.1 This Agreement contains the entire Agreement between thepartieswith
respect to the20-percent assessment fee on non-federal share IGTSpursuant to the Intergovernmental
Agreement(s) RegardingtheTransfer of Public Funds, andasdescribedinparagraph 1, and supersedes
any previousor contemporaneous oralor written proposals,statements, discussions, negotiationsor other
agreements between thetransferring entity and State DHCS. ThisAgreement isnot, however, intendedto
be thesoleagreement between thepartiesonmatters relatingto the funding
and
administrationofthe Medi-Calprogram. One or more otheragreements may existbetweenthe parties regarding suchothermatters, and otheragreements may be enteredinto in the future. This Agreement shallnot modify the
terms of anyotheragreement between the parties.
3.2 Time is oftheessence inthisAgreement.
3.3 Eachparty hereby represents thattheperson(s) executing this Agreement on its behalf is dulyauthorizedto doso.
4. State Authority. Except as expressly provided herein, nothing in this Agreement shallbe
construedto limit, restrict, ormodify State DHCS’ powers, authorities, anddutiesunder federal andstate
law and regulations.
5. Approval. ThisAgreement is ofno force andeffectuntilsigned by the parties.
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executedthis Agreement, on the date ofthelast
signaturebelow.
CITY OF SONOMA:
By: Date:
Carol Giovanatto, CityManager
i
s
THE STATE OF CALIFORNIA, DEPARTMENTOF HEALTH CARE SERVICES:
By: Date:
MeredithWurden, Assistant Deputy Director, HealthCare Financing
