Attachment C
Agreement with California Department of Health Care Services
CONTRACT # IGT-25-0017
INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement isenteredintobetween theCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (“DHCS”) and CITY OF NEWPORT BEACH (“GOVERNMENTAL FUNDING ENTITY”) with respectto thematters set forth below.
The partiesagree as follows:
AGREEMENT
Transfer of Public Funds
The GOVERNMENTAL FUNDING ENTITY agreesto make a transferLI of funds to DHCS pursuantto sectionsI4I64 and 14301.4 of the Welfare and Institutions Code.
The amount transferred shall be based on the sum of theapplicableratecategoryper member per month (“PMPM”) contributionincrementsmultipliedby member months, as reflectedin Exhibit
1. The GOVERNMENTAL FUNDING ENTITY agreesto initiallytransfer amounts that are calculatedusing the Estimated Member Months in Exhibit1,which willbe reconciled to actual enrollmentforthe serviceperiodof January 1,2025 through December 31, 2025 in accordance with Sub-Section 1.3of thisAgreement. The funds transferredshall be used as described in Sub- Section2.2 of thisAgreement. The funds shallbe transferredin accordance with the terms and conditions,includingschedule and amount, establishedby DHCS.
1.2 The GOVERNMENTAL FUNDING ENTITY shallcertifythatthe funds transferredqualifyforFederalFinancialParticipationpursuantto 42 C.F.R. part433, subpartB, and arenot derivedfrom impermissiblesourcessuch as recycledMedicaid payments. Federal money excluded from use as Statematch, impermissibletaxes,and non-bona fideprovider- l
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relateddonations.Impermissiblesourcesdo not includepatientcareor otherrevenue received from programs such as Medicare or Medicaid to the extentthatthe program revenue isnot obligatedto the Stateas thesourceof funding.
1.3 DHCS shallreconcilethe “Estimated Member Months,” in Exhibit 1,to actualenrollmentinHEALTH PLAN(S) fortheserviceperiodof January 1,2025 through December 31,2025 usingactualenrollmentfigurestakenfrom DHCS records. Enrollment reconciliationwilloccuron an ongoingbasisas updatedenrollmentfiguresbecome available.
Actual enrollmentfigureswillbe consideredfinaltwo years afterDecember 31, 2025. If reconciliation results in an increase to the total amount necessaryto fund the nonfederalshareof the payments describedin Sub-Section2.2,the GOVERNMENTAL FUNDING ENTITY agrees to transferany additionalfunds necessaryto coverthe difference. If reconciliation results in a decreasetothetotalamount necessaryto fund thenonfederalshareof thepayments describedin Sub-Section2.2,DHCS agreestoreturntheunexpended 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 againstfuturetransfers.
2. Acceptance and Use of TransferredFunds
2.1 DHCS shallexerciseitsauthorityunder section14164 of the Welfare and InstitutionsCode toacceptfundstransferredby theGOVERNMENTAL FUNDfNG ENTITY pursuantto thisAgreement as IntergovernmentalTransfer(IGTs),to use forthe purpose setforth in Sub-Section 2.2.
2.2 The fundstransferredby theGOVERNMENTAL FUNDING ENTITY pursuantto Section1 and Exhibit1 of thisAgreement shall be used to fund the non-federal share 2 Template Version - 1/2026
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of Medi-Cal Managed Care actuariallysound capitationratesdescribedin section14301.4(b)(4) of the Welfare and Institutions Code as reflected in the contributionPMPM and ratecategories reflected in Exhibit 1. The funds transferred shall be paid,togetherwith therelatedFederal FinancialParticipation,by DHCS to HEALTH PLAN(S) as partof HEALTH PLAN(S)’ capitationratesfortheserviceperiodof January 1,2025 through December 31, 2025, in accordance with section 14301.4 of the Welfare and Institutions Code.
DHCS shallseek FederalFinancialParticipationforthe capitationrates2.3 specifiedin Sub-Section 2.2to the fullextentpermittedby federallaw.
2.4 The partiesacknowledge thatDHCS willobtainany necessary approvals from the Centers for Medicare and Medicaid Services.
DHCS shallnot directHEALTH PLAN(S)’ expenditureof the payments2.5 receivedpursuantto Sub-Section2.2.
3. Assessment Fee
DHCS shallexerciseitsauthorityunder section14301.4 of the Welfare3.1 and InstitutionsCode to assessa 20 percentfeerelatedto the amounts transferredpursuantto Section 1 of thisAgreement, except as provided in Sub-Section 3.2. GOVERNMENTAL FUNDING ENTITY agreesto pay thefullamount of thatassessment in addition to the funds transferredpursuantto Section1 of thisAgreement.
The 20-percentassessment fee shallnot be appliedto any portionof funds3.2 transferredpursuant to Section 1 thatare exempt in accordance with sections14301.4(d) or 14301.5(b)(4)of the Welfare and InstitutionsCode. DHCS shall have sole discretion to determine the amount of the funds transferredpursuant to Section 1 thatwillnot be subjectto a 3 Template Version - 1/2026
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20 percentfee.DHCS has determinedthat$0.00 of thetransfer amounts will not be assessed a 20 percentfee,subjectto Sub-Section3.3.
The 20-percentassessment feepursuantto thisAgreement is non-3.3 refundableand shallbe wired to DHCS simultaneouslywith the transfer amounts made under Section 1 of thisAgreement. Ifatthe time of thereconciliationperformed pursuantto Sub- Section1.3of thisAgreement, thereisa change inthe amount transferredthatissubjectto the 20-percentassessment in accordance with Sub-Section 3.1,then a proportionaladjustmentto the assessment fee will be made.
Amendments4.
No amendment or modificationto thisAgreement shallbe binding on4.1 eitherpartyunlessmade inwritingand executedby both parties.
The partiesshallnegotiatein good faithto amend thisAgreement as4.2 necessaryand appropriateto implement the requirementsset forth in Section 2 of this Agreement.
5. Notices.Any and allnoticesrequired,permitted,or desiredto be given hereunder by one partyto the othershalleitherbe sentvia secureemail or submittedinwritingtotheother partypersonallyor by United StatesFirstClass,Certifiedor Registeredmail with postage prepaid,addressedto the otherpartyatthe addressas set forth below:
To the GOVERNMENTAL FUNDING ENTITY:
KristinThompson, EMS DivisionChief
100 Civic Center Drive
Newport Beach, CA 92660
(949) 644-3385
[email protected]
With copiesto:
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Raymund Reyes, Admin Manager
100 Civic Center Drive
Newport Beach, CA 92660
(949) 644-3352
[email protected]
JeffBoyles,FireChief
100 Civic Center Drive
Newport Beach, CA 92660
(949) 644-3101
[email protected]
LiliBanuelos, AssistantManagement Analyst
100 Civic Center Drive
Newport Beach, CA 92660
(949) 644-3360
[email protected]
To DHCS:
Vivian Beeck
CaliforniaDepartment of Health Care Services
CapitatedRates Development Division
1501 CapitolAve., MS 4413
Sacramento, CA 95814
[email protected]
Other Provisions6.
This Agreement containsthe entireAgreement between the partieswith6.1 respectto the Medi-Cal payments describedin Sub-Section2.2 of thisAgreement thatare funded by theGOVERNMENTAL FUNDfNG ENTITY, and supersedesany previousor contemporaneous oralor writtenproposals,statements,discussions,negotiationsor other agreements between the GOVERNMENTAL FUNDING ENTITY and DHCS relatingto the subjectmatterof thisAgreement. This Agreement isnot, however, intended to be the sole agreement between the partieson mattersrelatingto the funding and administrationof the Medi- 5 Template Version - 1/2026
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Cal program. This Agreement shallnot modify theterms of any otheragreement, existingor enteredintointhe future,between the parties.
The non-enforcementor otherwaiver of any provisionof thisAgreement6.2 shallnot be construedas a continuingwaiver or as a waiver of any otherprovisionof this Agreement.
6.3 Sections2 and 3 of thisAgreement shallsurvivethe expirationor terminationof thisAgreement.
Nothing inthisAgreement isintendedto conferany rightsor remedies on6.4 any thirdparty,including,withoutlimitation,any provider(s)or groups of providers,or any right to medical servicesforany individual(s)or groups of individuals.Accordingly,thereshallbe no thirdpartybeneficiaryof thisAgreement.
6.5 Time isof the essencein thisAgreement.
Each partyherebyrepresentsthattheperson(s)executingthisAgreement6.6 on itsbehalfisduly authorizedto do so.Any requiredsignature(s)on any documents must be in compliance with CaliforniaGovernment Code section16.5and any otherapplicablestateor federalregulations.
StateAuthority.Except as expresslyprovidedherein,nothing in thisAgreement7. shallbe construedto limit,restrict,or modify theDHCS’ powers, authorities,and dutiesunder Federaland Statelaw and regulations.
8. Approval. This Agreement isof no force and effectuntilsigned by theparties.
9. Term. This Agreement shallbe effectiveas of January 1,2025 and shallexpireas of June 30,2028 unlessterminatedearlierby DHCS through writtennotificationor by mutual agreement of the parties.
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SIGNATURES
IN WITNESS WHEREOF, thepartiesheretohave exeeutedthisAgreement, on the dateof the lastsignaturebelow.
CITY OF NEWPORT BEACH:
Date:By:
Lauren Kleiman, Mayor
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
Date:By:
Sean Barber,DivisionChief,CapitatedRates Development Division APPROVED AS TO FORM:
CITY ATTORNEY'S OFFICE
Data: ^7 /
Cty^torneyBy:
Aaron' D.Harp,
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Exhibit 1
Health Plan Funding Entity Rating Region Seroice Period Participation % CalOptima Cityof Newport Beach Orange 1/2025-12/2025 0.16% Estimated
Contribution (Non-
Federal Share)
28,330
Contribution
PMPM
Estimated Member
Months*Category of Aid SIS/UIS
$Child SIS S0.01 2,833,005
Child S SUlS 210,335
$Adult SIS s0.02 904,169 18,083
Adult S $UlS 0.02 611,283 12,226
S $Adult Expansion
Adult Expansion
SIS 3,060,473
S $UlS 823,965
$ $SPD SIS 0.05 381,326 19,066
$ $SPD UlS 0.02 140,678 2,814
$ $SPD Dual SIS 0.02 1,310,516 26,210
SPD Dual $ $UlS 0.01 12,948 129
$ $LTC SIS 0.05 2,061 103
$ sLTC UlS 0.02 1,575 32
$ sLTC Dual SIS 0.02 28,943 579
s sLTC Dual UlS 0.01 271 3
$ sWCM SIS 0.07 104,167 7,292
S $WCM UlS 0.02 4,850 97
SEst. FE Total 10,430,565 114,964
* Note thatEstimated Member Months are subjectto variation,and the actualtotalContribution (Non-Federal Share)may differfrom the amount listedhere. * FMAP isa weighted blend of multipleFMAPs.
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