In Process
Docusign Envelope ID: 74C32F8E- AD74- 4C96- 9C17- 057DA611 C700 DS
AGR- 7741 5 CONTRACT# IGT- 23- 0012
INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (" DHCS") and CITY OF ORANGE(" GOVERNMENTAL FUNDING ENTITY") with respect to the matters set forth below.
The parties agreeasfollows:
AGREEMENT
1. Transfer of Public Funds
1. 1 The GOVERNMENTAL FUNDING ENTITY agrees to make a transfer of funds to DHCS pursuant to sections 14164and 14301.4 of the Welfare and Institutions Code.
The amount transferred shall be basedon the sum of the applicable rate category per member per month(" PMPM") contribution increments multiplied by member months, asreflected in Exhibit
1. The GOVERNMENTAL FUNDING ENTITY agreesto initially transfer amounts that are calculated using the Estimated Member Months in Exhibit 1, which will be reconciled to actual enrollment for the service period of January 1, 2023 through December 31, 2023 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 scheduleand amount, establishedby DHCS.
1.2 The GOVERNMENTAL FUNDING ENTITY shall certify that the funds transferred qualify for FederalFinancial Participation pursuantto 42 C.F.R. part 433, subpartB, and are not derived from impermissible sourcessuchasrecycled Medicaid payments, Federal money excluded from use as Statematch, impermissible taxes, and non-bona fide provider- 1 Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92 In Process
Docusign Envelope ID: 74C32F8E- AD74- 4G96- 9C17- 057DA611 G7UU CONTRACT # IGT- 23- 0012
relateddonations. Impermissiblesourcesdonot includepatientcareor otherrevenuereceived from programssuchasMedicareor Medicaidto theextentthattheprogramrevenueis not obligated to the Stateas the sourceof funding.
1.3 DHCS shall reconcile the " Estimated Member Months," in Exhibit 1, to actualenrollmentin HEALTH PLAN(S) for theserviceperiodof January1, 2023through December31, 2023usingactualenrollmentfigurestakenfrom DHCSrecords. Enrollment reconciliationwill occuron anongoingbasisasupdatedenrollmentfiguresbecomeavailable.
Actual enrollmentfigureswill beconsideredfinal two yearsafterDecember31, 2023. If reconciliation results in an increaseto the total amount necessaryto fund the nonfederal shareof the payments described in Sub-Section 2.2, the GOVERNMENTAL FUNDING ENTITY agrees to transferanyadditionalfundsnecessaryto coverthedifference. If reconciliationresultsin a decreaseto thetotal amountnecessaryto fundthenonfederalshareof thepaymentsdescribedin 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.
2. Acceptance and Use of Transferred Funds
2. 1 DHCS shall exerciseits authority under section 14164of the Welfare and Institutions Code to acceptfunds transferredby the GOVERNMENTAL FUNDING ENTITY pursuant to this Agreement as Intergovernmental Transfer( IGTs), to usefor the purpose setforth 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 usedto fund the non-federal share 2 Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92 In Process
uocusign Envelope ID: 74C32F8E- AD74- 4C96- 9C17- 057DA61 1 C TUU CONTRACT# IGT- 23- 0012
of Medi-CalManagedCareactuariallysoundcapitationratesdescribedin section14301.4(b)(4) of the Welfare and Institutions Code as reflected in the contribution PMPM and rate categories reflected in Exhibit 1. The funds transferred shall be paid, togetherwith the related Federal Financial Participation, by DHCS to HEALTH PLAN( S) aspart of HEALTH PLAN( S)' capitationratesfor theserviceperiodof January1, 2023throughDecember31, 2023, 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 necessaryapprovals 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.
3. Assessment Fee
3. 1 DHCS shall exerciseits authority under section 14301.4 of the Welfare and Institutions Code to assessa 20 percent fee related to the amountstransferred pursuant to Section 1 of this Agreement, except asprovided in Sub-Section 3.2. GOVERNMENTAL FUNDING ENTITY agreesto pay the full amount of that assessmentin addition to the funds transferred pursuant to Section 1 of this Agreement.
3. 2 The 20-percent assessmentfee shall not be applied to any portion of funds transferred pursuant to Section 1 that are exempt in accordancewith 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 1that will not be subject to a 3 Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92 In Process
Docusign Envelope ID: 74C32F8E- AD74- 4C96- 9C17- 057DA611C700 CONTRACT# IGT- 23- 0012
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 The20-percentassessmentfeepursuantto this Agreementis non- refundable and shall be wired to DHCS simultaneously with the transfer amountsmade 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 assessmentin accordancewith Sub-Section 3.1, then aproportional adjustment to the assessment fee will be made.
4. Amendments
4. 1 No amendmentor modification to this Agreement shall be binding on either party unless made in writing and executedby both parties.
4. 2 The parties shall negotiate in good faith to amendthis Agreement as necessaryand appropriate to implement the requirementsset forth in Section 2 of this Agreement.
5. Notices. Any and all notices required, permitted, or desiredto be given hereunder by one party to the other shall either be sent via secureemail or submitted in writing to the other party personally or by United StatesFirst Class, Certified or Registeredmail with postage prepaid, addressed to the other party at the address as set forth below:
To the GOVERNMENTAL FUNDING ENTITY:
Bryan Johnson, EMS Manager
300 E. Chapman Ave.
Orange, CA 92866
714) 288- 2503
[email protected]
4 Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92 In Process
Docusign Envelope ID: 74C32F8E- AD74- 4C96- 9C17- 057DA611C700 CONTRACT # IGT- 23- 0012
With copies to:
To DHCS:
Vivian Beeck
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., MS 4413
Sacramento, CA 95814
Vivian. Beeck@,dhcs.ca.gov
6. Other Provisions
6. 1 This Agreement containsthe entire Agreement between the parties with respectto theMedi-Calpaymentsdescribedin Sub-Section2.2 of thisAgreementthatarefunded by the GOVERNMENTAL FUNDING ENTITY, and supersedesany previous or contemporaneousoral or written proposals, statements, discussions, negotiations or other agreementsbetween the GOVERNMENTAL FUNDING ENTITY and DHCS relating to the subject matter of this Agreement. This Agreement is not, however, intended to be the sole agreementbetween 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 construedas a continuing waiver or asa 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.
5 Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92 In Process
Docusign Envelope ID: 74C32F8E- AD74- 4C96- 9C17- 057DA611 C700 CONTRACT# IGT- 23- 0012
6. 4 Nothingin this Agreementis intendedto conferanyrightsor remedieson anythirdparty, including, withoutlimitation, anyprovider(s)orgroupsof providers, oranyright to medicalservicesfor anyindividual(s) or groupsof individuals. Accordingly,thereshallbeno third party beneficiary of this Agreement.
6. 5 Time is of the essence in this Agreement.
6. 6 Eachpartyherebyrepresentsthattheperson(s) executingthis Agreement on its behalfis duly authorizedto do so. Any requiredsignature(s) onanydocumentsmustbe in compliance with California Government Code section 16.5 and any other applicable stateor federal regulations.
7. StateAuthority. Except as expresslyprovided herein, nothing in this Agreement shall be construedto 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 signedby the parties.
9. Term. This Agreement shall be effective asof January 1, 2023 and shall expire as of June30, 2026 unless terminated earlier by mutual agreementof the parties.
SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executedthis Agreement, on the date of the last signature below.
City of Orange:
By: 5Docugigned
by:
atit4 le• gdkr Date: 9/ 17/ 2024
Dame ' `ater, Mayor
ATTEST: APPROVED AS TO FORM:
p- DocuSigned by: DocuSigned by:
ftik- eDebs.,,, kb. l/ Ofa 6
fifffelleitan, City Clerk killacNfeffft4a, City Attorney Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92 In Process
Docusign Envelope ID: 74C32F8E- AD74- 4C96- 9C17- 057DA611 C700 CONTRACT# IGT- 23- 0012
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date:
David Bishop, Division Chief, Capitated RatesDevelopment Division 7 Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92 September 30, 2024
In Process
Docusign Envelope ID: 74C32F8E- AD74- 4C96- 9C17- 057DA611 C700 CONTRACT# IGT- 23- 0012
Exhibit 1
Health Plan Funding Entity County Service Period Participation% CalOptima City of Orange Orange 1/ 2023- 12/ 2023 1. 10% Contribution Estimated Member
Estimated
Category of Aid SIS/ UIS
PMPM Months*
Contribution( Non-
Federal Share)
Child SIS 0. 04 3, 472, 048 $ 138, 882
Child UIS 0. 01 148, 873 $ 1, 489
Adult SIS 0. 07 1, 423, 569 $ 99, 650
Adult UIS 0. 04 267, 683 $ 10, 707
ACA Optional Expansion SIS 0. 01 3, 773, 376 $ 37, 734 ACA Optional Expansion UIS 0. 02 419, 435 $ 8, 389
SPD SIS 0. 23 442, 469 $ 101, 768
SPD UIS 0. 20 86, 182 $ 17, 236
SPD/ Full- Dual SIS 0. 08 1, 299, 679 $ 103, 974
SPD/ Full- Dual UIS 0. 04 6, 355 $ 254
LTC SIS 0. 24 2, 597 $ 623
LTC UIS 0. 20 1, 559 $ 312
LTC/ Full- Dual SIS 0. 08 31, 893 $ 2, 551
LTC/ Full- Dual UIS 0. 04 124 $ 5
Whole Child Model SIS 0. 41 133, 436 $ 54, 709
Whole Child Model UIS 0. 14 4, 171 $ 584
Est. FE Total 11, 513, 449 $ 578, 867
Note that Estimated Member Months are subject to variation, and the actual total Contribution Non- Federal Share) may differ from the amount listed here.
FMAP is a weighted blend of multiple FMAPs.
8 Docusign Envelope ID: 129CBB9D-72A6-468D-B4F4-8F57F1114C92