CITY OF ORANGE
ASSISTANT CITY MANAGER www.cityoforange.org PHONE: (714) 744-2230 FAX: (714) 744-2245 ORANGE CIVIC CENTER 300 E. CHAPMAN AVENUE ORANGE, CA 92866-1591 P.O. BOX 449 October 18, 2022
Rafael Davtian
Division Chief
Capitated Rates Development Division
Department of Health Care Services
1501 Capitol Avenue, MS 4413
P.O. Box 997413
Sacramento, CA 95899-7413
Dear Mr. Davtian:
This letter confirms the intent of City of Orange, a governmental entity, Federal I.D. Number 95- 6000755, (Funding Entity) to work with the California Department of Health Care Services (DHCS) to participate in the Public Provider Ground Emergency Medical Transportation (GEMT) Intergovernmental Transfer (IGT) Program. Participation will include the Funding Entity providing an IGT in the amount of $1,135,419.99 payment to DHCS to be used for the non-federal share for the Public Provider GEMT IGT Program, for the service period of January 1, 2023 through December 31, 2023. This is a non-binding letter, stating our interest in helping to finance health improvements for Medi-Cal beneficiaries receiving services in our jurisdiction. The governmental entity’s funds are being provided voluntarily.
Below is a list of all NPI numbers associated with the Funding Entity mentioned above. 1922004555
City of Orange will contribute to the non-federal share of the Public Provider GEMT IGT Program add-on increase for Calendar Year 2023 (January 1, 2023 – December 31, 2023).We recognize that there will be an additional 10-percent fee payable to DHCS on the IGT amount, for the administrative costs of operating the Public Provider GEMT IGT Program.
The following individual from our organization will serve as the point of communication between our organization (as applicable) and DHCS, regarding our organization’s participation in the Public Provider GEMT IGT Program:
Katrin Bandhauer, Assistant Finance Director
714-744-2251
City of Orange
300 E. Chapman Ave.
Orange, CA 92866
[email protected]
Michelle Kresan, Budget Manager
714-744-2236
City of Orange
300 E. Chapman Ave.
Orange, CA 92866
[email protected]
Letter of Intent
October 18, 2022
*(3) Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
I certify, to the best of my knowledge, that the Funding Entity, defined as the governmental entity that provides the non-federal share of funding (i.e. cities, counties, special districts), is an eligible provider.*
I attest that I am authorized to sign this certification on behalf of the Funding Entity and that the statements in this letter are true and correct.
Sincerely,
Will Kolbow
Assistant City Manager
cc: Susan Galvan, Assistant City Manager
Katrin Bandhauer, Assistant Finance Director
Sean de Metropolis, Fire Chief, Orange Fire Department
Robert Stefano, Deputy Fire Chief, Orange Fire Department