City of Sacramento
City Council - 2PM Report
915 I Street Sacramento, CA 95814
www.cityofsacramento.org
File ID: 2022-01775 10/25/2022 Consent Item 06.
Revised Calendar Year (CY) 2021 Rate Range Intergovernmental Transfer (IGT) Program Contract with the California Department of Health Care Services (DHCS) [Published for 10-Day Review on 10/13/2022]
File ID: 2022-01775
Location: Citywide
Recommendation: Pass a Motion: 1) authorizing the City Manager or the City Manager’s designee to execute the revised Intergovernmental Agreement Regarding Transfer of Public Funds and Assessment Fee with DHCS; 2) authorizing the transfer of funds of up to approximately $4 million as reflected in Exhibit 1 to the IGT Agreement from the Fire Department's operating budget to DHCS and accept a reimbursement for Medi-Cal services of approximately $6 million of which approximately $4 million will reimburse the Fire Department's operating budget; 3) authorizing a transfer of any additional funds necessary and/or accept the return of unexpended funds; and 4) authorizing designation of the additional federal reimbursement of approximately $2 million to offset costs of providing Emergency Medical Services (EMS).
Contact: Iysha Jenkins, Senior Accountant Auditor, (916) 808-8569, [email protected], Fire Department
Presenter: None
Attachments:
1-Description/Analysis
2-Revised IGT CY2021 IGT Agreement Regarding Transfer of Public Funds with DHCS 3-Partially Signed IGT CY2021 Agreement
Description/Analysis
Issue Detail: The previous version of the IGT Agreement was approved by Council on December 14, 2021, and signed by City representatives, but never fully executed as it was never signed by the State. The revisions modify sections 3.3 and 3.5 and add new language to clarify the method for payment of the 20% assessment fee, allow for secure emailing of notices and clarifying signature compliance that was not part of the initial version of the CY2021 IGT Agreement. An additional contact was also added for notification(s) of deliveries.
File ID: 2022-01775 10/25/2022 Consent Item 06.
The IGT Program provides for the receipt of federal matching funds to support health services for Medi-Cal Managed Care beneficiaries served by the Fire Department. The Fire Department does not receive full reimbursement for the provision of medical services to Medi-Cal Managed Care patients.
Currently, the Fire Department receives approximately 20% in reimbursement of our Medi-Cal Managed Care costs from payments received from Medi-Cal Managed Care Health Plans (MMCHP).
The IGT Program requires the transfer of eligible local dollars from the City to the DHCS. DHCS receives additional Federal funding from the Centers for Medicare and Medicaid Services (CMS).
Since the funds must be used to support the Medi-Cal Managed Care program, DHCS transfers both the original contribution from the City and matched funds to the MMCHP who in turn makes those funds available to the City. The State and Federal governments review and approve all City program documents prior to any funds being sent to DHCS.
The City of Sacramento provides ambulance transports and meets the following IGT Program participation criteria:
1. Provides law enforcement services.
2. Has eminent domain authority.
3. Has taxing authority.
Policy Considerations: Participation in this program is consistent with Council’s adopted Budget Guideline to pursue new and enhance existing revenue sources as well as Council’s adopted Advanced Life Support (ALS) Revenue Recovery Policy. In addition, pursuant to City Code Section 3.56.090, contracts of $250,000 or more are to be approved by the City Council.
The Sacramento City Code Section 4.04.020 and the Council Rules of Procedure (Chapter 7, Section E.2.d) mandate that unless waived by 2/3 vote of the City Council, all labor agreements and all agreements greater than $1 million shall be made available to the public at least ten (10) days prior to Council action. This item was published for 10-day review on October 13, 2022, in compliance with the City Code.
Economic Impacts: None.
Environmental Considerations: This report concerns administrative activities that do not constitute a “project” as defined by Section 15378 of the California Environmental Quality Act (CEQA) Guidelines and is otherwise exempt pursuant to Section 15061(b) (3).
Sustainability: Not applicable.
Commission/Committee Action: None.
Rationale for Recommendation: Approval of the revised agreement is necessary for the City to participate in the IGT Program.
Financial Considerations: Upon approval of this agreement, the City will apply and request an
File ID: 2022-01775 10/25/2022 Consent Item 06.
amount to be reimbursed through the IGT program. This amount will help the City recover additional reimbursement of our unreimbursed Medi-Cal costs incurred in period of January 1, 2021, through December 31, 2021, consistent with the ALS Revenue Recovery Policy.
Local Business Enterprise (LBE): Not applicable.
CONTRACT
ROUTING SHEET
Contract Cover/Routing Form: Must Accompany ALL Contracts; however, it is NOT part of the contract.
General Information (Required)
Original Contract # (supplements only): ________ Supplement/Addendum #: ___________________ Assessor’s Parcel Number(s): ________________________________________________________________ Contract Effective Date: _________ Contract Expiration Date (if applicable): _________ $ Amount (Not to Exceed): ______________________ Adjusted $ Amount (+/-): _____________________ Other Party: ______________________________________________________________________________ Project Title: _____________________________________________________________________________ Project #: ____________________________________ Bid/RFQ/RFP #: ___________________________ City Council Approval: if YES, Council File ID#: __________ Contract Processing Contacts
Department: ______________________________
Contract Coordinator: _______________________
Project Manager: ___________________________
______
Department Review and Routing
(Signature) (Date)
(Signature) (Date)
(Signature) (Date)
(Signature) (Date)
Special Instruction/Comments (i.e. recording requested, other agency signatures required, etc.) _______________________________________________________________________________________ ------------------FOR CLERK & IT DEPARTMENTS ONLY – DO NOT WRITE BELOW THIS LINE------------------
CONTRACT # 21-10187
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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 SACRAMENTO (“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 period of January 1, 2021 through December 31, 2021 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, 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- CONTRACT # 21-10187
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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 period of January 1, 2021 through December 31, 2021 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 December 31, 2021. 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.
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) CONTRACT # 21-10187
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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, together with the related Federal Financial Participation, by DHCS to HEALTH PLAN(S) as part of HEALTH PLAN(S)’ capitation rates for the service period of January 1, 2021 through December 31, 2021, 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.
3. 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 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.
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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 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:
Anne Iturraran, Fire Administrative Manager
City of Sacramento
5770 Freeport Blvd, Suite 200
Sacramento, CA 95822
[email protected]
With copies to:
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Allison Narramore, Administrative Officer
City of Sacramento
5770 Freeport Blvd, Suite 200
Sacramento, CA 95822
[email protected]
To DHCS:
Vivian Beeck
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., MS 4413
Sacramento, CA 95814
[email protected]
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 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.
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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.
7. 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 January 1, 2021 and shall expire as of June 30, 2024 unless terminated earlier by mutual agreement of the parties.
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SIGNATURES
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, on the date of the last signature below.
THE CITY OF SACRAMENTO:
Approved as to Form: _________________ Date: ______________________ Gary P. Lindsey, Jr., Senior Deputy City Attorney, City of Sacramento
Attest By: __________________________ Date: ______________________ Wendy Klock-Johnson, Assistant Clity Clerk, City of Sacramento
By: Date: _______________________
Howard Chan, City Manager, City of Sacramento
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date: _______________________
Rafael Davtian, Division Chief, Capitated Rates Development Division
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Exhibit 1
Health Plan:
Rating Region:
Service Period
Rate Category Contribution PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child - non MCHIP 1.01$ 32,687 33,014$ Child - MCHIP 0.72 $ 11,287 8,127$ Adult - non MCHIP 2.61$ 20,175 52,657$ Adult - MCHIP 2.07 $ 519 1,074$ ACA Optional Expansion 0.75$ 63,387 47,540$ SPD 6.90 $ 8,948 61,741$ SPD/Full-Dual 1.66 $ 2,481 4,118$ Estimated Total 139,484 208,271$
Aetna Better Health
Sacramento
1/2021 - 12/2021
Health Plan:
Rating Region:
Service Period
Rate Category Contribution PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child - non MCHIP 0.66$ 177,018 116,832$ Child - MCHIP 0.47 $ 51,018 23,978$ Adult - non MCHIP 1.65$ 95,809 158,085$ Adult - MCHIP 1.21 $ 1,248 1,510$ ACA Optional Expansion 0.49$ 224,157 109,837$ SPD 4.72 $ 75,430 356,030$ SPD/Full-Dual 1.11 $ 31,500 34,965$ Estimated Total 656,180 801,237$
Molina Healthcare
Sacramento
1/2021 - 12/2021
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Health Plan:
Rating Region:
Service Period
Rate Category Contribution PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child - non MCHIP 0.17$ 428,752 72,888$ Child - MCHIP 0.12 $ 142,893 17,147$ Adult - non MCHIP 0.47$ 233,114 109,564$ Adult - MCHIP 0.34 $ 2,751 935$ ACA Optional Expansion 0.10$ 426,720 42,672$ SPD 1.35 $ 142,306 192,113$ SPD/Full-Dual 0.32 $ 53,874 17,240$ Estimated Total 1,430,410 452,559$
Health Net of California
Sacramento
1/2021 - 12/2021
Health Plan:
Rating Region:
Service Period
Rate Category Contribution PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child - non MCHIP 0.63$ 359,024 226,185$ Child - MCHIP 0.45 $ 187,629 84,433$ Adult - non MCHIP 1.70$ 210,222 357,377$ Adult - MCHIP 1.25 $ 3,653 4,566$ SPD 3.53 $ 71,674 253,009$ SPD/Full-Dual 0.85 $ 92,257 78,418$ Estimated Total 924,459 1,003,988$
Kaiser Foundation Health Plan
Sacramento
1/2021 - 12/2021
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* Note that Estimated Member Months are subject to variation, and the actual total Contribution (Non-Federal Share) may differ from the amount listed here.
Health Plan:
Rating Region:
Service Period
Rate Category Contribution PMPM
Estimated Member
Months*
Estimated
Contribution (Non-
Federal Share)
Child - non MCHIP 0.22$ 739,192 162,622$ Child - MCHIP 0.14 $ 219,924 30,789$ Adult - non MCHIP 0.54$ 430,090 232,249$ Adult - MCHIP 0.40 $ 4,395 1,758$ ACA Optional Expansion 0.15$ 701,222 105,183$ SPD 1.50 $ 217,358 326,037$ SPD/Full-Dual 0.38 $ 86,645 32,925$ Estimated Total 2,398,826 891,563$
Anthem Blue Cross
Sacramento
1/2021 - 12/2021