City of Sacramento
City Council - 5PM Report
915 I Street Sacramento, CA 95814
www.cityofsacramento.org
File ID: 2023-01487 11/14/2023 Consent Item 28.
Agreements: Participation in the Rate Range Intergovernmental Transfer (IGT) Program with the California Department of Health Care Services (DHCS) and Medi-Cal Managed Care Plan Providers (MMCPP) (Two-Thirds Vote Required)
File ID: 2023-01487
Location: Citywide
Recommendation: Pass a Motion 1) waiving the 10-day review requirement for agreements greater than $1 million; 2) authorizing the City Manager or the City Manager’s designee to execute a) the Intergovernmental Transfer Agreement Regarding Transfer of Public Funds and Assessment Fee with the California State Department of Health Care Services (DHCS); and b) the Health Plan-Provider Agreements with participating Medi-Cal Managed Care Plan Providers; 3) authorizing transfer of funds up to approximately $3.7 million from the Fire Department’s operating budget to DHCS; 4) accepting reimbursement for Medi-Cal services of approximately $9 million, of which, approximately $3.7 million will reimburse the Fire Department’s operating budget; and 5) authorizing designation of the additional federal reimbursement of approximately $5.3 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-IGT Agreement Regarding Transfer of Public Funds with DHCS 3-Health Plan Provider Agreement with Kaiser Foundation Health Plan 4-Health Plan Provider Agreement with Aetna Better Health of California 5-Health Plan Provider Agreement with Health Net of California 6-Health Plan Provider Agreement with Molina
7-Health Plan Provider Agreement with Anthem Blue Cross Description/Analysis
Issue Detail:
The Rate Range Intergovernmental Transfer (IGT) program provides an opportunity to receive
File ID: 2023-01487 11/14/2023 Consent Item 28.
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 medical services to Medi-Cal Managed Care patients.
Currently, the Fire Department receives approximately 25% in reimbursement of our Medi-Cal Managed Care costs from payments received from Medi-Cal Managed Care Plan Provider(s) (MMCPP).
The IGT requires the transfer of eligible local dollars from the City to the Department of Health Care Services (DHCS). DHCS uses the funds to receive 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 MMCPP, making those funds available to the City. The State and Federal governments will review and approve the documents the City submits to participate in the IGT program before any funds are sent to DHCS.
The amount the City initially transfers will be calculated using the Estimated Member Months (refer to Exhibit 1 of the IGT Agreement Regarding Transfer of Public Funds and Assessment Fee with DHCS), which will be reconciled to actual enrollment for the service periods of January 1, 2022, through December 31, 2022. Enrollment reconciliation will occur continuously as updated figures are made available. If, after the enrollment reconciliation, there is an increase in the amount needed to fund the non-federal share, the City will be required to transfer additional funds to cover the difference. If, after the enrollment reconciliation, there is a decrease in the amount needed to fund the non-federal share, the City can choose to receive the unexpended funds from DHCS. If DHCS and the City mutually agreed upon, amounts due to or owed by the City may be offset against future transfers. Actual enrollment figures of the respective period will be considered final two years after December 31, 2022.
The City of Sacramento provides ambulance transports and meets the following IGT participation criteria:
1. Provides law enforcement services.
2. Has eminent domain authority.
3. Has taxing authority.
As such, the City of Sacramento participates in an IGT program to request funds to recover unreimbursed Medi-Cal costs.
Policy Considerations: Participation in this program is consistent with Council’s adopted Budget Guidelines to pursue new and enhance existing revenue sources and the Council’s adopted Advanced Life Support (ALS) Revenue Recovery policy.
File ID: 2023-01487 11/14/2023 Consent Item 28.
Pursuant to City Charter Section 20 and City Code Section 3.56.090, the City Council holds the delegable authority to approve execution of contracts of $250,000 or more for supplies or nonprofessional services.
The Sacramento Code Section 4.04.020 and Council Rules of Procedure (Chapter 7, Section E.2.d) mandate that, unless waived by a 2/3 vote of the City Council, all labor agreements and all agreements greater than $1,000,000 shall be made available to the public at least ten (10) days prior to City Council action.
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 are otherwise exempt under Section 15061(b)(3).
Sustainability: Not Applicable.
Commission/Committee Action: None.
Rationale for Recommendation:
The department is recommending Council to pass a motion that will waive the 10-day public posting requirements of City Code section 4.04.020.C for agreements greater than $1 million. This motion is being requested based on the strict and short deadlines to return all agreements to Department of Health Care Services.
The following agreements and amendments must be in place for the City to participate in the IGT program:
a. The Intergovernmental Transfer Agreement: This contract specifies the amount to be transferred by the City to DHCS. It requires DHCS to use the transferred funds to increase capitation payments to a specified healthcare plan and to secure federal match funds, or if that is not possible, to return the transferred funds. The parties to this contract are the City and DHCS.
This portion of the agreement commits the City to pay DHCS 20% of the amount transferred as an administrative fee. This fee is refundable if the IGT does not go forward. b. The Health Plan-Provider Agreements: These agreements are amendments between the MMCPPs and the City. These contract amendments commit the MMCPPs to pay the City a specified amount of the IGT-funded capitation rate increases they receive from DHCS within 30 days of receiving those funds from the State. The MMCPPs will deduct an administrative
File ID: 2023-01487 11/14/2023 Consent Item 28.
fee of 2%, 2.5%, or 5% from the amount that will be remitted to the City. The amendments specify how the City will treat these funds from an accounting standpoint. The MMCPPs participating in the program are Aetna Better Health of California, Anthem Blue Cross, Health Net of California, Kaiser Foundation Health Plan, and Molina Healthcare.
Financial Considerations: Upon approval of these agreements, the City will apply and request an amount to be reimbursed through the IGT program. This amount will help the City recover additional reimbursement of our previously unreimbursed Medi-Cal costs incurred from January 1, 2022, through December 31, 2022, consistent with the ALS Revenue Recovery policy. To receive the reimbursement from MMCPPs, the City will be required to transfer up to approximately $3.7 million to DHCS to cover the City’s Non-federal share of the managed-care costs. This share includes the 20% fee assessed by the State to cover their costs to administer the IGT program.
The City will recover our non-federal share amount from the reimbursements received through the IGT program. This amount is net of the 2%, 2.5%, or 5% administrative fee assessed by the MMCPPs.
The funding for the City’s contribution will come from the Fire Department’s EMS operating budget.
The payment received from the MMCPPs will reimburse EMS for the contribution. The additional reimbursement will offset the EMS costs, consistent with the ALS Revenue Recovery policy.
Local Business Enterprise (LBE): Not Applicable.
Plan-Provider Agreement City of Sacramento Fire Department and Kaiser Foundation Health Plan, Inc. Page 1 of 7 HEALTH PLAN-PROVIDER AGREEMENT BY AND BETWEEN KAISER FOUNDATION HEALTH PLAN, INC. AND THE CITY OF SACRAMENTO VIA ITS FIRE DEPARTMENT TO IMPLEMENT THE RATING PERIOD 2022 RATE RANGE IGTs This Health Plan-Provider Agreement (“Agreement”) is made by and between Kaiser Foundation Health Plan, Inc., a California nonprofit public benefit corporation, on behalf of its Northern California region, hereinafter referred to as “PLAN,” and the City of Sacramento hereinafter referred to as “GOVERNMENTAL FUNDING ENTITY” via its Fire Department, hereinafter referred to as “PROVIDER.” RECITALS: WHEREAS, PLAN is a health care service plan licensed under and subject to the Knox-Keene Care Service Plan Act of 1975, as amended, and is a party to a Medi-Cal managed care contract with the California Department of Health Care Services (“State DHCS”) to arrange and pay for the provision of covered Medi-Cal health care services to eligible Medi-Cal members, including Medi-Cal members residing in Sacramento County; WHEREAS, PROVIDER is a local government entity duly licensed by the State of California to provide emergency ambulance transports; and WHEREAS, PLAN and PROVIDER desire to enter into an Agreement to provide for Medi-Cal managed care capitation rate range increases to PLAN as a result of intergovernmental transfers (“IGTs”) from GOVERNMENTAL FUNDING ENTITY to State DHCS to maintain the availability of Medi-Cal health care services to Medi-Cal beneficiaries. NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows: 1. 2022 IGT Capitation Rate Range Increases to PLAN A. Payment Should PLAN receive any Medi-Cal managed care capitation rate range increases from State DHCS where the nonfederal share is funded by the GOVERNMENTAL FUNDING ENTITY, via its Fire Department, specifically pursuant to the provisions of the Intergovernmental Agreement regarding transfer of public funds, IGT-22-0014, effective for the period of January 1, 2022 through December 31, 2022 for Intergovernmental Transfer Medi-Cal Managed Care Rate Range Increases (“IGT MMCRRIs”), PLAN shall pay to PROVIDER the amount of the IGT MMCRRIs received from State DHCS, in accordance with Paragraph 1.E Plan-Provider Agreement City of Sacramento Fire Department and Kaiser Foundation Health Plan, Inc. Page 2 of 7 below regarding the form and timing of Local Medi-Cal Managed Care Rate Range (“LMMCRR”) IGT Payments. LMMCRR IGT Payments paid to PROVIDER shall not replace or supplant any other amounts paid or payable to PROVIDER by PLAN. B. Health Plan Retention (1) As compensation for its administrative services in connection with this Agreement, PLAN shall retain a five percent (5%) administrative fee based on the total amount of the IGT MMCRRI received from State DHCS. Each provider’s share of the five percent (5%) fee shall be calculated based on that provider’s proportionate share of the LMMCRR IGT payment made by PLAN in Sacramento County. (2) PLAN will not retain any other portion of the IGT MMCRRIs received from the State DHCS other than those specified above. C. Conditions for Receiving Local Medi-Cal Managed Care Rate Range IGT Payments As a condition for receiving LMMCRR IGT Payments, PROVIDER shall, as of the date the particular LMMCRR IGT Payment is due: (1) Remain a Medi-CAL enrolled provider for ambulance transport services; (2) Remain in material compliance with its obligations under the Provider; Agreement and applicable law; and (3) Not issue a notice of termination of this Health Plan- Provider Agreement. D. Schedule and Notice of Transfer of Non-Federal Funds PROVIDER shall notify PLAN when funding has been made pursuant to the Intergovernmental Agreement within five (5) business days of such transfer. E. Form and Timing of Payments PLAN agrees to pay LMMCRR IGT Payments to PROVIDER in the following form and according to the following schedule: (1) Subject to Paragraph 1.K below, PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER.
Plan-Provider Agreement City of Sacramento Fire Department and Kaiser Foundation Health Plan, Inc. Page 3 of 7 (2) PLAN will pay the LMMCRR IGT Payments to PROVIDER no later than thirty (30) calendar days after PLAN’s receipt of the IGT MMCRRI from State DHCS. F. Consideration (1) As consideration for the LMMCRR IGT Payments, PROVIDER shall use the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT Payments in the following manner:(a) The LMMCRR IGT Payments shall represent compensation for Medi- Cal services rendered to Medi-Cal PLAN members by PROVIDER during the State fiscal year to which the LMMCRR IGT Payments apply. (b) To the extent that total payments received by PROVIDER for any State fiscal year under this Agreement exceed the cost of Medi-Cal services provided to Medi-Cal beneficiaries by PROVIDER during that fiscal year, any remaining LMMCRR IGT Payment amounts shall be retained by PROVIDER to be expended for health care services. Retained LMMCRR IGT Payment amounts may be used by the PROVIDER in either the State fiscal year for which the payments are received or subsequent State fiscal years. (2) For purposes of subsection (1) ( b) above, if the retained LMMCRR IGT Payments, if any, are not used by PROVIDER in the State fiscal year received, retention of funds by PROVIDER will be established by demonstrating that the retained earnings account of PROVIDER at the end of any State fiscal year in which it received payments based on LMMCRR IGT Payments funded pursuant to the Intergovernmental Agreement, has increased over the unspent portion of the prior State fiscal year’s balance by the amount of LMMCRR IGT Payments received, but not used. These retained PROVIDER funds may be commingled with other GOVERNMENTAL FUNDING ENTITY funds for cash management purposes provided that such funds are appropriately tracked and only the depositing facility is authorized to expend them. (3) Both parties agree that none of these funds, either from the GOVERNMENTAL FUNDING ENTITY or federal matching funds, will be recycled back to the GOVERNMENTAL FUNDING ENTITY’S general fund, the State, or any other intermediary organization. Payments made under the terms of this Agreement constitute patient care revenues. G. PLAN’s Oversight Responsibilities Plan-Provider Agreement City of Sacramento Fire Department and Kaiser Foundation Health Plan, Inc. Page 4 of 7 PLAN's oversight responsibilities regarding PROVIDER's use of the LMMCR IGT Payments shall be limited as described in this paragraph. PLAN shall request, within thirty (30) calendar days after the end of each State fiscal year in which LMMCR IGT Payments were transferred to PROVIDER, a written confirmation that states whether and how PROVIDER complied with the provisions set forth in Paragraph 1.F above. In each instance, PROVIDER shall provide PLAN with written confirmation of compliance within thirty (30) calendar days of PLAN's request. H. Cooperation Among Parties Should disputes or disagreements arise regarding the ultimate computation or appropriateness of any aspect of the LMMCRR IGT Payments, PROVIDER and PLAN agree to work together in all respects to support and preserve the LMMCRR IGT Payments to the full extent possible and permitted by law, on behalf of the safety net in Sacramento County. I. Reconciliation Within one hundred twenty (120) calendar days after the end of each of PLAN’s fiscal years in which LMMCRR IGT Payments were made to PROVIDER, PLAN shall perform a reconciliation of the LMMCRR IGT Payments transmitted to the PROVIDER during the preceding fiscal year to ensure that the supporting amount of IGT MMCRRIs were received by PLAN from State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCRR IGT Payments made in error to PROVIDER within thirty (30) calendar days after receipt from PLAN of a written notice of the overpayment error, unless PROVIDER submits a written objection to PLAN. Any such objection shall be resolved in accordance with Section H (above) of this Agreement. The reconciliation processes established under this paragraph are distinct from the indemnification provisions set forth in Paragraph 1.J below. PLAN agrees to transmit to the PROVIDER any underpayment of LMMCRR IGT Payments within thirty (30) calendar days of the PLAN’s identification of such underpayment. J. Indemnification PROVIDER shall defend, indemnify and hold PLAN, its affiliated and related entities, and its and their respective officers, employees and agents harmless from and against any and all liability, loss, expense (including reasonable attorney’s fees), or claims for injury or damages arising out of the performance of this Agreement but only in proportion to and to the extent such liability, loss, expense, attorney’s fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of PROVIDER, its officers, employees or agents.
Plan-Provider Agreement City of Sacramento Fire Department and Kaiser Foundation Health Plan, Inc. Page 5 of 7 PLAN shall defend, indemnify and hold PROVIDER, its officers, employees and agents harmless from and against any and all liability, loss, expense (including reasonable attorney’s fees), or claims for injury or damages arising out of the performance of this Agreement but only in proportion to and to the extent such liability, loss, expense, attorney’s fees, or claims or injury or damages are caused by or result from the negligent or intentional acts or omissions of PLAN, its officers, employees or agents. K. Severability If a court of competent jurisdiction declares any provision of this Agreement or application thereof to any person or circumstances to be invalid or if any provision of this Agreement contravenes any federal, state or county statute, ordinance, or regulation, the remaining provisions of this Agreement or the application thereof shall remain valid and the remaining provisions of this Agreement shall remain in full force and effect, and to the extent the provisions of this Agreement are severable. L. Status of Contractor Each party is, and shall at all times be deemed to be, an independent contractor and shall be wholly responsible for the manner in which it performs the services required of it by the terms of this agreement. Each party is entirely responsible for compensating staff, subcontractors, and consultants employed by that party. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between PLAN and PROVIDER or any of either party’s employees, agents, consultants, or subcontracts. Each party assumes exclusively the responsibility for the acts of its employees, agents, consultants, or subcontractors as they relate to the services to be provided during the course and scope of their employment. Each party, its agents, employees, consultants, or subcontractors shall not be entitled to any rights or privileges of the other party’s employees and shall not be considered in any manner to be employees of the other party. M. Remittance Information PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER using the same mechanism through which compensation and payments are normally paid to PROVIDER. Below are details if payment will be mailed to PROVIDER.
Plan-Provider Agreement City of Sacramento Fire Department and Kaiser Foundation Health Plan, Inc. Page 6 of 7 Allison Narramore, Administrative Officer (for Fire’s Finance Administrative Manager) City of Sacramento Fire Department5770 Freeport Blvd., Suite 200 Sacramento, CA 95822-3516 Phone: (916) 808-8065 Email: [email protected] 2. Term The term of this Agreement shall commence on January 1, 2022 and shall terminate on December 31, 2025.
Plan-Provider Agreement City of Sacramento Fire Department and Kaiser Foundation Health Plan, Inc. Page 7 of 7 SIGNATURESPLAN: Kaiser Foundation Health Plan, Inc. By: ___________________________________________ Date________________ Alfonse L. UpshawSenior Vice President and Chief Financial Officer, Northern California Region Kaiser Foundation Health Plan & Hospitals PROVIDER: City of Sacramento via its Fire Department By: ___________________________________________ Date_____________ Howard Chan, City Manager, 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 City Clerk, City of Sacramento
1 Plan-Provider Agreement, City of Sacramento Fire Department and Aetna Better Health, 2022 Rate Range IGTs HEALTH PLAN-PROVIDER AGREEMENTBY AND BETWEEN AETNA BETTER HEALTH OF CALIFORNIA AND THE CITY OF SACRAMENTO VIA ITS FIRE DEPARTMENT TO IMPLEMENT THE 2022 RATE RANGE IGTs This Health Plan-Provider Agreement (Agreement) is made by and between Aetna Better Health of California, a corporation, the City of Sacramento Department, . RECITALS: WHEREAS, PLAN is a health care service plan licensed under and subject to the Knox-Keene Care Service Plan Act of 1975, as amended, and is a party to a Medi-Cal managed care contract with DHCS to arrange and pay for the provision of covered Medi-Cal health care services to eligible Medi-Cal members, including Medi-Cal members residing in Sacramento County; WHEREAS, PROVIDER is a local government entity duly licensed by the State of California to provide emergency ambulance transports; WHEREAS, PLAN and PROVIDER desire to enter into an Agreement to provide for Medi-Cal managed care capitation rate increases to PLAN as a result of IGTs from GOVERNMENTAL FUNDING ENTITY to State DHCS to maintain the availability of Medi-Cal health care services to Medi-Cal beneficiaries. NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows: 1. 2022 IGT Medi-Cal Managed Care Capitation Rate Range Increases to PLAN A. Payment Should PLAN receive any Medi-Cal managed care capitation rate increases from State DHCS where the nonfederal share is funded by the GOVERNMENTAL FUNDING ENTITY specifically pursuant to the provisions of the Intergovernmental Agreement Regarding Transfer of Public Funds, #22-0014, effective for the period of January 1, 2 Plan-Provider Agreement, City of Sacramento Fire Department and Aetna Better Health, 2022 Rate Range IGTs 2022 through December 31, 2022 for Intergovernmental Transfer Medi-Cal Managed the IGT MMCRRIs received from State DHCS, in accordance with Paragraph 1.E below regarding the form and timing of Local Medi-Cal Managed Care Rate Range replace or supplant any other amounts paid or payable to PROVIDER by PLAN. B. Health Plan Retention (1) As compensation for its administrative services in connection with this Agreement, PLAN shall retain a two percent (2%) administrative fee based on the total amount of the IGT MMCRRI received from State DHCSthe two percent (2share of the LMMCRR IGT Payments made by PLAN in Sacramento County. (2) PLAN will not retain any other portion of the IGT MMCRRIs received from the State DHCS other than those specified above. C. Conditions for Receiving Local Medi-Cal Managed Care Rate Range IGT Payments As a condition for receiving LMMCRR IGT Payments, PROVIDER shall, as of the date the particular LMMCRR IGT Payment is due: (1) Remain a participating provider in the PLAN and not issue a notice of termination of the Agreement; and (2) Maintain its current emergency response services for PLAN Medi-Cal beneficiaries. D. Schedule and Notice of Transfer of Non-Federal Funds PROVIDER shall notify PLAN when funding has been made pursuant to the Intergovernmental Agreement within five (5) business days of such transfer. E. Form and Timing of Payments PLAN agrees to pay LMMCRR IGT Payments to PROVIDER in the following form and according to the following schedule:
3 Plan-Provider Agreement, City of Sacramento Fire Department and Aetna Better Health, 2022 Rate Range IGTs (1) PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER using the same mechanism through which compensation and payments are normally paid to PROVIDER (e.g., electronic transfer). (2) PLAN will pay the LMMCRR IGT Payments to PROVIDER no later than thirty (30) calendar days after receipt of the IGT MMCRRI from State DHCS. F. Consideration (1) As consideration for the LMMCRR IGT Payments, PROVIDER shall use the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT Payments in the following manner: (a) The LMMCRR IGT Payments shall represent compensation for Medi-Cal services rendered to Medi-Cal PLAN members by PROVIDER during the State fiscal year to which the LMMCRR IGT Payments apply. (b) To the extent that total payments received by PROVIDER for any State fiscal year under this Agreement exceed the cost of Medi-Cal services provided to Medi-Cal beneficiaries by PROVIDER during that fiscal year, any remaining LMMCRR IGT Payment amounts shall be retained by PROVIDER to be expended for health care services. Retained LMMCRR IGT Payment amounts may be used by the PROVIDER in either the State fiscal year for which the payments are received or subsequent State fiscal years. (2) For purposes of subsection (1) ( b) above, if the retained LMMCRR IGT Payments, if any, are not used by PROVIDER in the State fiscal year received, retention of funds by PROVIDER will be established by demonstrating that the retained earnings account of PROVIDER at the end of any State fiscal year in which it received payments based on LMMCRR IGT Payments funded pursuant to the Intergovernmental Agreement, has increased over the unspent portion of the prior State fiscal balance by the amount of LMMCRR IGT Payments received, but not used. These retained PROVIDER funds may be commingled with other GOVERNMENTAL FUNDING ENTITY funds for cash management purposes provided that such funds are appropriately tracked and only the depositing facility is authorized to expend them. (3) Both parties agree that none of these funds, either from the GOVERNMENTAL FUNDING ENTITY or federal matching funds, will be recycled back 4 Plan-Provider Agreement, City of Sacramento Fire Department and Aetna Better Health, 2022 Rate Range IGTs intermediary organization. Payments made under the terms of this Agreement constitute patient care revenues. G. PLAN's oversight responsibilities regarding PROVIDER's use of the LMMCRR IGT Payments shall be limited as described in this paragraph. PLAN shall request, within thirty (30) calendar days after the end of each State fiscal year in which LMMCRR IGT Payments were transferred to PROVIDER, a written confirmation that states whether and how PROVIDER complied with the provisions set forth in Paragraph 1.F above. In each instance, PROVIDER shall provide PLAN with written confirmation of compliance within thirty (30) calendar days of PLAN's request. H. Cooperation Among Parties Should disputes or disagreements arise regarding the ultimate computation or appropriateness of any aspect of the LMMCRR IGT Payments, PROVIDER and PLAN agree to work together in all respects to support and preserve the LMMCRR IGT Payments to the full extent possible and permitted by law on behalf of the safety net in Sacramento County. I. Reconciliation Within one s fiscal years in which LMMCRR IGT Payments were made to PROVIDER, PLAN shall perform a reconciliation of the LMMCRR IGT Payments transmitted to the PROVIDER during the preceding fiscal year to ensure that the supporting amount of IGT MMCRRIs were received by PLAN from State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCRR IGT Payments made in error to PROVIDER within thirty (30) calendar days after receipt from PLAN of a written notice of the overpayment error, unless PROVIDER submits a written objection to PLAN. Any such objection shall be resolved in accordance with Section H (above) of this Agreement. The reconciliation processes established under this paragraph are distinct from the indemnification provisions set forth in Section J below. PLAN agrees to transmit to the PROVIDER any underpayment of LMMCRR IGT Payments within thirty (30) calendar days of the 5 Plan-Provider Agreement, City of Sacramento Fire Department and Aetna Better Health, 2022 Rate Range IGTs J. Indemnification PROVIDER shall defend, indemnify and hold PLAN, its affiliated and related entities, and its and their respective officers, employees and agents harmless from and claims for injury or damages arising out of the performance of this Agreement but only in proportion to and to the extent such liability, loss, expense, attofor injury or damages are caused by or result from the negligent or intentional acts or omissions of PROVIDER, its officers, employees or agents. PLAN shall defend, indemnify and hold PROVIDER, its officers, employees and agents harmless from and against any and all liability, loss, expense (including performance of this Agreement but only in proportion to and to the extent such liability, loss, expense, afrom the negligent or intentional acts or omissions of PLAN, its officers, employees or agents. K. Severability If a court of competent jurisdiction declares any provision of this Agreement or application thereof to any person or circumstances to be invalid or if any provision of this Agreement contravenes any federal, state or county statute, ordinance, or regulation, the remaining provisions of this Agreement or the application thereof shall remain valid and the remaining provisions of this Agreement shall remain in full force and effect, and to the extent the provisions of this Agreement are severable. L. Status of Contractor Each party is, and shall at all times be deemed to be, an independent contractor and shall be wholly responsible for the manner in which it performs the services required of it by the terms of this agreement. Each party is entirely responsible for compensating staff, subcontractors, and consultants employed by that party. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between PLAN and PROVIDER or any of either exclusively the responsibility for the acts of its employees, agents, consultants, or subcontractors as they relate to the services to be provided during the course and scope of their employment. Each party, its agents, employees, consultants, or 6 Plan-Provider Agreement, City of Sacramento Fire Department and Aetna Better Health, 2022 Rate Range IGTs employees and shall not be considered in any manner to be employees of the other party. M. Remittance Information PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER using the same mechanism through which compensation and payments are normally paid to PROVIDER. Below are details if payment will be mailed to PROVIDER. Allison Narramore, Manager) City of Sacramento Fire Department 5770 Freeport Blvd., Suite 200 Sacramento, CA 95822-3516 Phone: (916) 808-8065 Email: [email protected] 2. Term The term of this Agreement shall commence on January 1, 2022 and shall terminate on December 31, 2023. 7Plan-Provider Agreement, City of Sacramento Fire Department and Aetna Better Health, 2022 Rate Range IGTs SIGNATURESPLAN: Aetna Better Health of CaliforniaBy: Date:Verne Brizendine, Chief Executive Officer PROVIDER: City of Sacramento via its Fire DepartmentBy: Date:Howard Chan, City Manager, City of SacramentoApproved as to Form: Date: Gary P. Lindsey, Jr., Senior Deputy City Attorney, City of SacramentoAttest By: Date: Wendy Klock-Johnson, Assistant City Clerk, City of Sacramento 10/26/2023
1 Template Version – 2018 Plan Provider Agreement for City of Sacramento and Health Net for 2022 IGTs HEALTH PLAN-PROVIDER AGREEMENT AMENDMENT 9 TO AGREEMENT BETWEEN HEALTH NET OF CALIFORNIA, INC. AND THE CITY OF SACRAMENTO VIA ITS FIRE DEPARTMENT This Amendment is made, by and between Health Net of California, Inc., a California corporation licensed pursuant to Health and Safety Code section 1349 et seq. to act as a health plan hereinafter referred to as "PLAN", and City of Sacramento via its Fire Department, hereinafter referred to as "PROVIDER." RECITALS: WHEREAS, PLAN and PROVIDER have previously entered into an Agreement effective January 1, 2013; WHEREAS, Health Net Community Solutions, Inc. (HNCS), a corporate entity licensed under Health and Safety Code Section 1349 et seq. has a contract with the California Department of Health Care Services (State DHCS) pursuant to Welfare and Institutions Code Section 14087.3 to act as a Medi-Cal managed care plan. HNCS has contracted with Health Net of California, Inc. to fulfill its responsibilities for the provision of Medi-Cal covered services for eligible Medi-Cal members. Health Net of California, Inc. has subsequently entered into the Agreement referenced above, and amendments to it, to allow PROVIDER to render such services to HNCS Medi-Cal members in Sacramento County. For purposes of this Amendment, Health Net of California, Inc. and Health Net Community Solutions, Inc. shall collectively be referred to as “PLAN;” WHEREAS, PROVIDER provides 9-1-1 emergency medical response and transport for the City of Sacramento and in that capacity serves all patients in need, including Medi-Cal beneficiaries. PROVIDER provides advanced life support paramedic services, including 12-lead ECG monitoring, advanced airway interventions and Advanced Cardiac Life Support medication consistent with the latest American Heart Association guidelines. PROVIDER currently deploys seventeen 24-hour ALS ambulances,up to three flex ALS ambulances when additional staffing and equipment are available, and a recently deployed Mobile Integrated Health Unit(s) (MIH) temporarily for sixty days, or until further notice, due to the Coronavirus Disease 2019 (COVID-19) pandemic; WHEREAS, PLAN and PROVIDER desire to amend the Agreement to provide for Medi-Cal managed care capitation rate increases to PLAN as a result of intergovernmental transfers (“IGTs”) from PROVIDER (GOVERNMENTAL FUNDING ENTITY) to the California Department of Health Care Services (“State DHCS”) to maintain the availability of Medi-Cal health care services to Medi-Cal beneficiaries. NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows: Amendment 9 of the Agreement is added to read as follows:
2 Template Version – 2018 Plan Provider Agreement for City of Sacramento and Health Net for 2022 IGTs 2022 IGT MEDI-CAL MANAGED CARE CAPITATION RATE RANGE INCREASES 1. IGT Capitation Rate Range Increases to PLAN A. Payment Should PLAN receive any Medi-Cal managed care capitation rate increases from State DHCS where the nonfederal share is funded by the GOVERNMENTAL FUNDING ENTITY specifically pursuant to the provisions of the Intergovernmental Agreement Regarding Transfer of Public Funds, IGT-22-0014 (“Intergovernmental Agreement”) effective for the period January 1, 2022 through December 31, 2022 for Intergovernmental Transfer Medi-Cal Managed Care Rate Range Increases (“IGT MMCRRIs”), PLAN shall pay to PROVIDER the amount of the IGT MMCRRIs received from State DHCS, in accordance with paragraph 1.E below regarding the form and timing of Local Medi-Cal Managed Care Rate Range (“LMMCRR”) IGT Payments. LMMCRR IGT Payments paid to PROVIDER shall not replace or supplant any other amounts paid or payable to PROVIDER by PLAN. B. Health Plan Retention (1) The PLAN shall not impose a fee or retention amount, or reduce other payments to a county public hospital health system, that would result in a direct or indirect reduction to the payments authorized under Welfare and Institutions Code Section 14301.5. (2) The PLAN shall retain a two percent (2%) administrative fee based on the total amount of the IGT MMCRRIs received from DHCS for PLAN’s cost to administer this program. Each provider’s share of the two percent (2%) fee shall be calculated based on that provider’s proportionate share of the LMMCRR IGT payments made by Plan in Sacramento County. (3) PLAN will not retain any other portion of the IGT MMCRRIs received from the State DHCS other than those mentioned above. C. Conditions for Receiving Local Medi-Cal Managed Care Rate Range IGT Payments As a condition for receiving LMMCRR IGT Payments, PROVIDER shall, as of the date the particular LMMCRR IGT Payment is due: (1) remain a participating provider in the PLAN and not issue a notice of termination of the Agreement; (2) maintain its current emergency response services for PLAN Medi-Cal beneficiaries. 3 Template Version – 2018 Plan Provider Agreement for City of Sacramento and Health Net for 2022 IGTs D. Schedule and Notice of Transfer of Non-Federal FundsThe GOVERNMENTAL FUNDING ENTITY shall notify the PLAN within five (5) business days after PROVIDER’s funds referred to in the Intergovernmental Transfer Agreement have been transferred to the State. E. Form and Timing of PaymentsPLAN agrees to pay LMMCRR IGT Payments to PROVIDER in the following form and according to the following schedule:(1) PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER using the same mechanism through which compensation and payments are normally paid to PROVIDER (e.g., check, electronic transfer). (2) PLAN will pay the LMMCRR IGT Payments to PROVIDER no later than thirty (30) calendar days after receipt of the IGT MMCRRIs from State DHCS. F. Consideration (1) As consideration for the LMMCRR IGT Payments, PROVIDER shall use the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT Payments in the following manner:(a) The LMMCRR IGT Payments shall represent compensation for Medi-Cal services rendered to Medi-Cal PLAN members by PROVIDER during the State fiscal year to which the LMMCRR IGT Payments apply. (b) To the extent that total payments received by PROVIDER for any State fiscal year under this Amendment exceed the cost of Medi-Cal services provided to Medi-Cal beneficiaries by PROVIDER during that fiscal year, any remaining LMMCRR IGT Payment amounts shall be retained by PROVIDER to be expended for health care services. Retained LMMCRR IGT Payment amounts may be used by the PROVIDER in either the State fiscal year for which the payments are received or subsequent State fiscal years. (2) For purposes of subsection (1) (b) above, if the retained LMMCRR IGT Payments, if any, are not used by PROVIDER in the State fiscal year received, retention of funds by PROVIDER will be established by demonstrating that the retained earnings account of PROVIDER at the end of any State fiscal year in which it received payments based on LMMCRR IGT Payments funded pursuant to the Intergovernmental Agreement, has increased over the unspent portion of the prior State fiscal year’s balance by the amount of LMMCRR IGT Payments received, but not used. These retained PROVIDER funds may be commingled with other GOVERNMENTAL FUNDING ENTITY’S funds for cash management purposes 4 Template Version – 2018 Plan Provider Agreement for City of Sacramento and Health Net for 2022 IGTs provided that such funds are appropriately tracked and only the depositing facility is authorized to expend them. (3) Both parties agree that none of these funds, either from the GOVERNMENTAL FUNDING ENTITY or federal matching funds will be recycled back to the GOVERNMENTAL FUNDING ENTITY’S general fund, the State, or any other intermediary organization. Payments made by the health plan to providers under the terms of this Amendment constitute patient care revenues. G. PLAN’s Oversight ResponsibilitiesPLAN’s oversight responsibilities regarding PROVIDER’s use of the LMMCRR IGT Payments shall be limited as described in this paragraph. PLAN shall request, within thirty (30) calendar days after the end of each State fiscal year in which LMMCRR IGT Payments were transferred to PROVIDER, a written confirmation that states whether and how PROVIDER complied with the provisions set forth in Paragraph 1.F above. In each instance, PROVIDER shall provide PLAN with written confirmation of compliance within thirty (30) calendar days of PLAN’s request.H. Cooperation Among Parties Should disputes or disagreements arise regarding the ultimate computation or appropriateness of any aspect of the LMMCRR IGT Payments, PROVIDER and PLAN agree to work together in all respects to support and preserve the LMMCRR IGT Payments to the full extent possible on behalf of the safety net in Sacramento County. I. ReconciliationWithin one hundred twenty (120) calendar days after the end of each of PLAN’s fiscal years in which LMMCRR IGT Payments were made to PROVIDER, PLAN shall perform a reconciliation of the LMMCRR IGT Payments transmitted to the PROVIDER during the preceding fiscal year to ensure that the supporting amount of IGT MMCRRIs were received by PLAN from State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCRRIGT Payments made in error to PROVIDER within thirty (30) calendar days after receipt from PLAN of a written notice of the overpayment error, unless PROVIDER submits a written objection to PLAN. Any such objection shall be resolved in accordance with any dispute resolution processes set forth in the Agreement or otherwise in good faith by the parties. The reconciliation processes established under this paragraph are distinct from the indemnification provisions set forth in Section J below. PLAN agrees to transmit to the PROVIDER any underpayment of LMMCRR IGT Payments within thirty (30) calendar days of PLAN’s identification of such underpayment. 5 Template Version – 2018 Plan Provider Agreement for City of Sacramento and Health Net for 2022 IGTs J. Indemnification (1) Anything to the contrary contained in the Agreement notwithstanding, PROVIDER shall indemnify and hold PLAN harmless against any losses, claims, demands, liabilities, court costs, judgments and expenses, imposed by a court or otherwise incurred by PLAN after the execution date of this Amendment as a result of PLAN’s receipt of IGT rate increases or payment of LMMCRR IGT payments, including but not limited to the following circumstances:(2) In the event that DHCS, the Department of Human Health and Services or any other federal or state agency recoups, offsets, or otherwise withholds any monies from or fails to provide any monies to PLAN, or PLAN is denied any monies to which it otherwise would have been entitled, for any reason relating to the Medi-Cal managed care capitation rate increases arising from the Intergovernmental Agreement as such increases flow through the Medi-Cal Agreement between PLAN and the State and this Agreement, including but not limited to (a) State DHCS’ use of IGT Rate Increases or LMMCRR IGT payments to supplant or replace other amount in violation of the restrictions in Section 2.2 of the Intergovernmental Agreement; (b) the failure of the IGT Rate Increases to qualify in whole or part for federal participation pursuant to 42 C.F.R. part 433, subpart B; or (c) overpayment of the IGT Rate Increases to PLAN by State DHCS, PLAN shall have a right to immediately recoup, offset or withhold any and all such amounts from payments otherwise due to PROVIDER. Recovery by PLAN pursuant to this section shall include, but not be limited to, reduction in future LMMCRR IGT payments paid to PROVIDER in an amount equal to the amount of IGT Rate Increases payments recovered from PLAN, or by reduction of any other amounts owed by PLAN to PROVIDER. K. Severability If a court of competent jurisdiction declares any provision of this Agreement or application thereof to any person or circumstances to be invalid or if any provision of this Agreement contravenes any federal, state or county statute, ordinance, or regulation, the remaining provisions of this Agreement or the application thereof shall remain valid and the remaining provisions of this Agreement shall remain in full force and effect, and to the extent the provisions of this Agreement are severable. L. Status of Contractor Each party is, and shall at all times be deemed to be, an independent contractor and shall be wholly responsible for the manner in which it performs the services required of it by the terms of this agreement. Each party is entirely responsible for compensating staff, subcontractors, and consultants employed by that party. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between PLAN and PROVIDER or any of either party’s employees, agents, consultants, or subcontracts. Each party assumes exclusively the responsibility for the acts of its employees, agents, consultants, or 6 Template Version – 2018 Plan Provider Agreement for City of Sacramento and Health Net for 2022 IGTs subcontractors as they relate to the services to be provided during the course and scope of their employment. Each party, its agents, employees, consultants, or subcontractors shall not be entitled to any rights or privileges of the other party’s employees and shall not be considered in any manner to be employees of the other party. M. Remittance Information The IGT-funded payments made by the PLAN pursuant only to this Amendment, shall be mailed to the PROVIDER at the address set forth below: Allison Narramore, Administrative Officer (for Fire’s Finance Administrative Manager) City of Sacramento Fire Department 5770 Freeport Blvd., Suite 200 Sacramento, CA 95822-3516 Phone: (916) 808-8065 Email: [email protected] 2. Term The term of this Amendment shall commence on January 1, 2022 and shall terminate on December 31, 2025. All other terms and provisions of said Agreement shall remain in full force and effect so that all rights, duties and obligations, and liabilities of the parties hereto otherwise remain unchanged; provided, however, if there is any conflict between the terms of this Amendment and the Agreement, then the terms of this Amendment shall govern. 7 Template Version – 2018 Plan Provider Agreement for City of Sacramento and Health Net for 2022 IGTs SIGNATURESHEALTH PLAN: HEALTH NET OF CALIFORNIA INC. By: __________________________________ Date: ____________ Jessica Sellner, Plan Chief Financial Officer, Health Net of California, Inc. PROVIDER: CITY OF SACRAMENTO VIA ITS FIRE DEPARTMENT By: ______________________________________ Date: _____________ Howard Chan, City Manager, 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 City Clerk, City of Sacramento
CY 2022 IGT Health Plan-Provider Agreement for Molina Healthcare and City of Sacramento Fire Department p. 1 HEALTH PLAN-PROVIDER AGREEMENTAMENDMENT TO AGREEMENT BETWEEN MOLINA HEALTHCARE AND CITY OF SACRAMENTO VIA ITS FIRE DEPARTMENT AMENDMENT 9 This Amendment is made by and between Molina Healthcare, a California corporation licensed pursuant to Health and Safety Code section 1349 et seq. to act as a health plan hereinafter referred to as "PLAN," and the City of Sacramento via its Fire Department, hereinafter referred to as "PROVIDER." RECITALS: WHEREAS, PLAN and PROVIDER have previously entered into an Agreement effective January 1, 2013; WHEREAS, Section XIII of such Agreement provides for amending such Agreement; WHEREAS, Molina Healthcare, a corporate entity licensed under Health and Safety Code Section 1349 et seq., has a contract with the California Department of Health Care Services (State DHCS) pursuant to Welfare and Institutions Code Section 14087.3 to act as a Medi-Cal managed care plan. Molina Healthcare has subsequently entered into the Agreement referenced above, and amendments to it, to allow PROVIDER to render such services to Molina Healthcare Medi-Cal members in Sacramento County; WHEREAS, PROVIDER is a City that through its Fire Department provides 9-1-1 emergency medical response and transport for the City of Sacramento and in that capacity serves all patients in need, including Medi-Cal beneficiaries. PROVIDER provides advanced life support paramedic services, including 12-lead ECG monitoring, advanced airway interventions and Advanced Cardiac Life Support medication consistent with the latest American Heart Association guidelines. PROVIDER currently deploys seventeen 24-hour ALS ambulances, up to three flex ALS ambulances when additional staffing and equipment are available, and a recently deployed Mobile Integrated Health Unit(s) (MIH) temporarily for sixty days, or until further notice, due to the Coronavirus Disease 2019 (COVID-19) pandemic; and, WHEREAS, PLAN and PROVIDER desire to amend the Agreement to provide for Medi-Cal managed care capitation rate increases to PLAN as a result of intergovernmental transfers (“IGTs”) from PROVIDER (GOVERNMENTAL FUNDING ENTITY) to the California Department of Health Care Services (“State DHCS”) to maintain the availability of Medi-Cal health care services to Medi-Cal beneficiaries. NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows: Amendment 9 of the Agreement is added to read as follows: 2022 IGT MEDI-CAL MANAGED CARE CAPITATION RATE RANGE INCREASES CY 2022 IGT Health Plan-Provider Agreement for Molina Healthcare and City of Sacramento Fire Department p. 2
1. IGT Capitation Rate Range Increases to PLANA. Payment Should PLAN receive any Medi-Cal managed care capitation rate increases from State DHCS where the nonfederal share is funded by the GOVERNMENTAL FUNDING ENTITY’s Intergovernmental Agreement Regarding Transfer of Public Funds, #22-#####, effective for the period January 1, 2022 through December 31, 2022 for Intergovernmental Transfer Medi-Cal Managed Care Rate Range Increases (“IGT MMCRRIs”), PLAN shall pay to PROVIDER the amount of the IGT MMCRRIs received from State DHCS, in accordance with paragraph 1.E below regarding the form and timing of Local Medi-Cal Managed Care Rate Range (“LMMCRR”) IGT Payments. LMMCRR IGT Payments paid to PROVIDER shall not replace or supplant any other amounts paid or payable to PROVIDER by PLAN. B. Health Plan Retention (1) The PLAN shall retain a two percent (2%) administrative fee based on the total amount of the IGT MMCRRIs received from DHCS for PLAN’s cost to administer this program. Each provider’s share of the two percent (2%) fee shall be calculated based on that provider’s proportionate share of the LMMCRR IGT payments made by PLAN in SacramentoCounty. (2) PLAN will not retain any other portion of the IGT MMCRRIs received from the State DHCS other than those mentioned above. C. Conditions for Receiving Local Medi-Cal Managed Care Rate Range IGT Payments As a condition for receiving LMMCRR IGT Payments, PROVIDER shall, as of the date the particular LMMCRR IGT Payment is due: (1) remain a participating provider in the PLAN and not issue a notice of termination of the Agreement; and (2) maintain its current emergency response services for PLAN Medi-Cal beneficiaries. D. Schedule and Notice of Transfer of Non-Federal FundsGOVERNMENTAL FUNDING ENTITY shall notify the PLAN within five (5) business days after the funds referred to in the Intergovernmental Transfer Agreement have been transferred to the State.
CY 2022 IGT Health Plan-Provider Agreement for Molina Healthcare and City of Sacramento Fire Department p. 3 E. Form and Timing of Payments PLAN agrees to pay LMMCRR IGT Payments to PROVIDER in the following form and according to the following schedule: (1) PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER using the same mechanism through which compensation and payments are normally paid to PROVIDER (e.g., electronic transfer). After retaining the PLAN’s administrative fee, as shown in Section B above, PLAN will pay PROVIDER a percent of the remaining LMMCRR IGT payment equal to the PROVIDER’s contribution as a percent of total governmental entity contributions to this IGT. (2) PLAN will pay the LMMCRR IGT Payments to PROVIDER no later than thirty (30) calendar days after receipt of the IGT MMCRRIs from State DHCS. F. Consideration (1) As consideration for the LMMCRR IGT Payments, PROVIDER shall use the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT Payments in the following manner: (a) The LMMCRR IGT Payments shall represent compensation for Medi-Cal services rendered to Medi-Cal PLAN members by PROVIDER during the State fiscal year to which the LMMCRR IGT Payments apply. (b) To the extent that total payments received by PROVIDER for any State fiscal year under this Amendment exceed the cost of Medi-Cal services provided to Medi-Cal beneficiaries by PROVIDER during that fiscal year, any remaining LMMCRR IGT Payment amounts shall be retained by PROVIDER to be expended for health care services. Retained LMMCRR IGT Payment amounts may be used by the PROVIDER in either the State fiscal year for which the payments are received or subsequent State fiscal years. (2) For purposes of subsection (1) (b) above, if the retained LMMCRR IGT Payments, if any, are not used by PROVIDER in the State fiscal year received, retention of funds by PROVIDER will be established by demonstrating that the retained earnings account of PROVIDER at the end of any State fiscal year in which it received payments based on LMMCRR IGT Payments funded pursuant to the Intergovernmental Agreement, has increased over the unspent portion of the prior State fiscal year’s balance by the amount of LMMCRR IGT Payments received, but not used. These retained PROVIDER funds may be commingled with other GOVERNMENTAL FUNDING ENTITY’S funds for cash management purposes provided that such funds are appropriately tracked and only the depositing facility is authorized to expend them. (3) Both parties agree that none of these funds, either from the GOVERNMENTAL FUNDING ENTITY or federal matching funds will be recycled back to the GOVERNMENTAL FUNDING ENTITY’S general fund, the State, or any other intermediary CY 2022 IGT Health Plan-Provider Agreement for Molina Healthcare and City of Sacramento Fire Department p. 4 organization. Payments made by the health plan to providers under the terms of this Amendment constitute patient care revenues. G. PLAN’s Oversight Responsibilities PLAN’s oversight responsibilities regarding PROVIDER’s use of the LMMCRR IGT Payments shall be limited as described in this paragraph. PLAN shall request, within thirty (30) calendar days after the end of each State fiscal year in which LMMCRR IGT Payments were transferred to PROVIDER, a written confirmation that states whether and how PROVIDER complied with the provisions set forth in Paragraph 1.F above. In each instance, PROVIDER shall provide PLAN with written confirmation of compliance within thirty (30) calendar days of PLAN’s request. H. Cooperation Among Parties Should disputes or disagreements arise regarding the ultimate computation or appropriateness of any aspect of the LMMCRR IGT Payments, PROVIDER and PLAN agree to work together in all respects to support and preserve the LMMCRR IGT Payments to the full extent possible on behalf of the safety net in Sacramento County. I. Reconciliation Within one hundred twenty (120) calendar days after the end of each of PLAN’s fiscal years in which LMMCRR IGT Payments were made to PROVIDER, PLAN shall perform a reconciliation of the LMMCRR IGT Payments transmitted to the PROVIDER during the preceding fiscal year to ensure that the supporting amount of IGT MMCRRIs were received by PLAN from State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCRRIGT Payments made in error to PROVIDER within thirty (30) calendar days after receipt from PLAN of a written notice of the overpayment error, unless PROVIDER submits a written objection to PLAN. Any such objection shall be resolved in accordance with the dispute resolution processes set forth in Section VIII of the Agreement and Section K below. The reconciliation processes established under this paragraph are distinct from the indemnification provisions set forth in Section J below. PLAN agrees to transmit to the PROVIDER any underpayment of LMMCRR IGT Payments within thirty (30) calendar days of PLAN’s identification of such underpayment.
CY 2022 IGT Health Plan-Provider Agreement for Molina Healthcare and City of Sacramento Fire Department p. 5 J. Indemnification PLAN and PROVIDER agree to indemnify and hold harmless the other party for any losses or delays in capitation payments as a result of the LMMCRR IGT arising from the Intergovernmental Agreement. K. Dispute Resolution All disputes between the parties relating to this contract which cannot be resolved by mutual agreement or mediation, which shall be required prior to moving to arbitration, shall be resolved exclusively by arbitration in accordance with the provisions of this Subsection. Either party may commence arbitration by sending a written demand for arbitration to the other party setting forth the nature of the controversy, the dollar amount involved, if any, and the remedies sought. There shall be one (1) arbitrator. If the parties fail to select a mutually acceptable arbitrator within ten (10) days after the demand for arbitration is mailed, then the parties stipulate to arbitration before a single arbitrator sitting on the San Diego JAMS/Endispute panel, who is a retired judge and is selected in the sole discretion of the San Diego JAMS/Endispute office administrator. The parties shall share all interim costs of the arbitration until decision. The prevailing party shall be entitled to reimbursement by the other party of such party’s attorneys’ fees and costs and any arbitration fees and expenses incurred with the arbitration. The substantive law of the State of California shall be applied by the arbitrator. The parties shall have the rights of discovery as provided in Part 4 of the California Code of Civil Procedure and as provided for in Section 1283.05 of said Code. The California Code of Evidence shall apply to testimony and documents submitted to the arbitrator. Arbitration shall take place in San Diego, California. As soon as reasonably practicable, a hearing with respect to the dispute or matter to be resolved shall be conducted by the arbitrator. As soon as reasonably practicable thereafter, the arbitrator shall arrive at a final decision, which shall be reduced to writing, signed by the arbitrator and mailed to each of the parties and their legal counsel. All decisions of the arbitrator shall be final, binding and conclusive on the parties and shall constitute the only method of resolving disputes or matters. A court of appropriate jurisdiction may issue a writ to enforce the arbitrator’s decision. Judgment may be entered upon a decision in accordance with applicable law in any court having appropriate jurisdiction. L. Severability If a court of competent jurisdiction declares any provision of this Agreement or application thereof to any person or circumstances to be invalid or if any provision of this Agreement contravenes any federal, state or county statute, ordinance, or regulation, the remaining provisions of this Agreement or the application thereof shall remain valid and the remaining provisions of this Agreement shall remain in full force and effect, and to the extent the provisions of this Agreement are severable.
CY 2022 IGT Health Plan-Provider Agreement for Molina Healthcare and City of Sacramento Fire Department p. 6 M. Status of Contractor Each party is, and shall at all times be deemed to be, an independent contractor and shall be wholly responsible for the manner in which it performs the services required of it by the terms of this agreement. Each party is entirely responsible for compensating staff, subcontractors, and consultants employed by that party. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between PLAN and PROVIDER or any of either party’s employees, agents, consultants, or subcontractors. Each party assumes exclusively the responsibility for the acts of its employees, agents, consultants, or subcontractors as they relate to the services to be provided during the course and scope of their employment. Each party, its agents, employees, consultants, or subcontractors shall not be entitled to any rights or privileges of the other party’s employees and shall not be considered in any manner to be employees of the other party. N. Remittance Information The IGT-funded payments made by the PLAN pursuant only to this Amendment, shall be mailed to the PROVIDER at the address set forth below: Allison Narramore, Administrative Officer (for Fire’s Finance Administrative Manager) City of Sacramento Fire Department 5770 Freeport Blvd., Suite 200 Sacramento, CA 95822-3516 Phone: (916) 808-8065 Email: [email protected] 2. Term The term of this Amendment shall commence on January 1, 2022 and shall terminate on December 31, 2025. All other terms and provisions of said Agreement shall remain in full force and effect so that all rights, duties and obligations, and liabilities of the parties hereto otherwise remain unchanged; provided, however, if there is any conflict between the terms of this Amendment and the Agreement, then the terms of this Amendment shall govern.
CY 2022 IGT Health Plan-Provider Agreement for Molina Healthcare and City of Sacramento Fire Department p. 7 SIGNATURESHEALTH PLAN: MOLINA HEALTHCARE By: __________________________________ Date: ____________ Paul Van Duine, Vice President of Network Management and Operations, Molina HealthcarePROVIDER: CITY OF SACRAMENTO, VIA ITS FIRE DEPARTMENTBy: ___________________________________ Date: _____________ Howard Chan, City Manager, 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 City Clerk, City of Sacramento
ANTHEM BLUE CROSS INTERGOVERNMENTAL (IGT) HEALTH PLAN-PROVIDER AGREEMENT City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 1 This Agreement is made this ______ of ____________ 2023 by and between Anthem Blue Cross, a California corporation hereinafter referred to as "PLAN", and the City of Sacramento via its Fire Department, hereinafter referred to as "PROVIDER." RECITALS: WHEREAS, Anthem Blue Cross, a corporate entity licensed under Health and Safety code Section 1349 et seq., has a contract with the State Department of Health Care Services (“State DHCS”) pursuant to Welfare and Institutions Code Section 14087.3 to act as a Medi-Cal managed care plan and to serve the residents of Sacramento County; WHEREAS, PROVIDER is an incorporated City whose Fire Department provides emergency response and ambulance transport to Plan members residing in Sacramento County; and, WHEREAS, PLAN and PROVIDER desire to enter into an Agreement to provide for Medi-Cal managed care capitation rate increases to PLAN as a result of intergovernmental transfers ("IGTs") from PROVIDER (“GOVERNMENTAL FUNDING ENTITY”) to the California Department of Health Care Services ("State DHCS") to maintain the availability of Medi-Cal health care services to Medi-Cal beneficiaries. NOW, THEREFORE, PLAN and PROVIDER hereby agree as follows: A. Payment Should PLAN receive any Medi-Cal managed care capitation rate increases from State DHCS where the nonfederal share is funded by the GOVERNMENTAL FUNDING ENTITY specifically pursuant to the provisions of the Intergovernmental Agreement Regarding Transfer of Public Funds, IGT-22-0014 (“Intergovernmental Agreement”) effective for the periods of January 1, 2022 through December 31, 2022 for Intergovernmental Transfer Medi-Cal Managed Care Rate Range Increases (“IGT MMCRRIs”), PLAN shall pay to PROVIDER the amount of the IGT MMCRRIs received from State DHCS, in accordance with paragraph 1.E below regarding the form and timing of Local Medi-Cal Managed Care Rate Range (“LMMCRR”) IGT Payments. LMMCRR IGT Payments paid to PROVIDER shall not replace or supplant any other amounts paid or payable to PROVIDER by PLAN.
City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 2 B. Health Plan Retention (1) The PLAN shall retain a two and a half percent (2.5%) administrative fee based on the total amount of the IGT MMCRRI received from DHCS for PLAN’s cost to administer this program. Each provider’s share of the two and a half percent (2.5%) fee shall be calculated based on the provider’s proportionate share of the LMMCRR IGT payment made by PLAN in Sacramento County. (2) PLAN will not retain any other portion of the IGT MMCRRIs received from the State DHCS other than those mentioned above. C. Conditions for Receiving Local Medi-Cal Managed Care Rate Range IGT Payments As a condition for receiving LMMCRR IGT Payments, PROVIDER shall, as of the date the particular LMMCRR IGT Payment is due: (1) remain a participating provider for PLAN Medi-Cal patients; and, (2) maintain current emergency response and ambulance transport services for PLAN beneficiaries.D. Schedule and Notice of Transfer of Non-Federal FundsThe GOVERNMENTAL FUNDING ENTITY shall notify the PLAN within five (5) business days after the funds referred to in the Intergovernmental Transfer Agreement have been transferred to the State. E. Form and Timing of Payments PLAN agrees to pay LMMCRR IGT Payments to PROVIDER in the following form and according to the following schedule: (1) PLAN agrees to pay the LMMCRR IGT Payments to PROVIDER using the same mechanism through which compensation and payments are normally paid to PROVIDER (e.g., electronic transfer). (2) PLAN will pay the LMMCRR IGT Payments to PROVIDER no later than thirty (30) calendar days after receipt and reconciliation of the IGT MMCRRIs from State DHCS.
City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 3 F. Consideration (1) As consideration for the LMMCRR IGT Payments, PROVIDER shall use the LMMCRR IGT Payments for the following purposes and shall treat the LMMCRR IGT Payments in the following manner: (a) The LMMCRR IGT Payments shall represent compensation for Medi-Cal services rendered to Medi-Cal PLAN members by PROVIDER during the State fiscal year to which the LMMCRR IGT Payments apply. (b) To the extent that total payments received by PROVIDER for any State fiscal year under this Agreement exceed the cost of Medi-Cal services provided to Medi-Cal beneficiaries by PROVIDER during that fiscal year, any remaining LMMCRR IGT Paymentamounts shall be retained by PROVIDER to be expended for health care services. Retained LMMCRR IGT Payment amounts may be used by the PROVIDER in either the State fiscal year for which the payments are received or subsequent State fiscal years. (2) For purposes of subsection (1) (b) above, if the retained LMMCRR IGT Payments, if any, are not used by PROVIDER in the State fiscal year received, retention of funds by PROVIDER will be established by demonstrating that the retained earnings account of PROVIDER at the end of any State fiscal year in which it received payments based on LMMCRRIGT Payments funded pursuant to the Intergovernmental Agreement, has increased over the unspent portion of the prior State fiscal year’s balance by the amount of LMMCRR IGT Paymentsreceived, but not used. These retained PROVIDER funds may be commingled with other GOVERNMENTAL FUNDING ENTITY funds for cash management purposes provided that such funds are appropriately tracked and only the depositing facility is authorized to expend them.(3) Both parties agree that none of these funds, either from the GOVERNMENTAL FUNDING ENTITY or federal matching funds will be recycled back to the GOVERNMENTAL FUNDING ENTITY’S general fund, the State, or any other intermediary organization. Payments made by the health plan to providers under the terms of this Agreement constitute patient care revenues. G. PLAN’s Oversight Responsibilities PLAN’s oversight responsibilities regarding PROVIDER’s use of the LMMCRRIGT Payments shall be limited as described in this paragraph. PLAN may request, within thirty (30) calendar days after the end of each State fiscal year in which LMMCRR IGT Payments were transferred to PROVIDER, a written confirmation that states whether and how PROVIDER complied with the provisions set forth in Paragraph 1.F above. In each instance, PROVIDER shall City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 4 provide PLAN with written confirmation of compliance within thirty (30) calendar days of PLAN’s request.H. Cooperation Among Parties Should disputes or disagreements arise regarding the ultimate computation or appropriateness of any aspect of the LMMCRR IGT Payments, PROVIDER and PLAN agree to work together in all respects to support and preserve the LMMCRR IGT Payments to the full extent possible on behalf of the safety net in Sacramento County. I. ReconciliationWithin one hundred twenty (120) calendar days after the end of each of PLAN’s fiscal years in which LMMCRR IGT Payments were made to PROVIDER, PLAN shall perform a reconciliation of the LMMCRR IGT Payments transmitted to the PROVIDER during the preceding fiscal year to ensure that the supporting amount of IGT MMCRRIs were received by PLAN from State DHCS. PROVIDER agrees to return to PLAN any overpayment of LMMCRRIGT Payments made in error to PROVIDER within thirty (30) calendar days after receipt from PLAN of a written notice of the overpayment error, unless PROVIDER submits a written objection to PLAN. Any such objection shall be resolved in accordance with the dispute resolution processes set forth in Section H of this Agreement or otherwise in good faith by the parties. The reconciliation processes established under this paragraph are distinct from the indemnification provisions set forth below.PLAN agrees to transmit to the PROVIDER any underpayment of LMMCRR IGT Payments within thirty (30) calendar days of PLAN’s identification of such underpayment. J. Indemnification Notwithstanding anything to the contrary contained in the Agreement, PROVIDER shall indemnify and hold PLAN harmless against any losses, claims, demands, liabilities, court costs, judgments and expenses, imposed by a court or otherwise incurred by PLAN after the execution date of the Agreement as a result of PLAN’s receipt of IGT MMCRRIs or payment of LMMCRR IGT, including but not limited to the following circumstances: (1) In the event that State DHCS, the Department of Health and Human Services or any other federal or state agency recoups, offsets, or otherwise withholds any monies from or fails to provide any monies to PLAN, or PLAN is denied any monies to which it otherwise would have been entitled, for any reason relating to the Medi-Cal managed care capitation rate increases arising from the Intergovernmental Agreement as such increases flow through the Medi-Cal Agreement between PLAN and the State and this Agreement, including but not limited to:
City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 5 (a) State DHCS’ failure to treat the IGT MMCRRISs or LMMCRR IGT Payments as set forth in the applicable sections of the Intergovernmental Agreement; (b) the failure of the IGT MMCRRIs to qualify for federal participation pursuant to 42 C.F.R. part 433, subpart B; or (c) overpayment of IGT MMCRRIs to PLAN by State DHCS, PLAN shall have a right to immediately recoup, offset or withhold any and all such amounts from payments otherwise due to PROVIDER. Recovery by PLAN pursuant to this section shall include, but not be limited to, reduction in future LMMCRRs paid to PROVIDER in an amount equal to the amount of IGT MMCRRI payments recovered from PLAN, or by reduction of any other amounts owed to PLAN by PROVIDER. (2) PLAN shall pursue an appeal, a lawsuit, or any other available legal action to challenge any recoupment by State DHCS, the Department of Health and Human Services, or any other federal or state agency that is not required by law, unless after consultation with PROVIDER and with good cause, PLAN acting reasonably determines that it is not in the best interest of PLAN and/or PROVIDER to do so; (3) At PLAN’s discretion PROVIDER shall either provide or arrange for legal representation on PLAN’s behalf or PLAN shall arrange for its own representation and be entitled to reasonable attorney’s fees and costs from PROVIDER for such representation, in addition to any and all other relief to which PLAN may be entitled, including but not limited to, the following circumstances: (a) If any action at law, suit in equity, arbitration, or administrative action is brought against PLAN by State DHCS, the Department of Health and Human Services, or any other federal or state agency or other individual or organization to: (i) enforce or interpret the IGT MMCRRIs or LMMCRRs; or (ii) recoup, offset, or otherwise withhold any monies from PLAN relating to the IGT MMCRRIs or LMMCRR IGT Payments; or (b) If PLAN brings any appeal, action at law, suit in equity, arbitration or administrative action against the State DHCS, or any other federal or state agency to (i) enforce or interpret the IGT MMCRRIs or LMMCRRs; or (ii) in response to an action described in subparagraph 1 or subparagraph 3(a) above; and City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 6 (4) If PLAN prevails in any appeal, action at law, suit in equity, arbitration, or administrative action taken against PLAN to enforce or interpret the IGT MMCRRIs or LMMCRRs, PLAN shall be entitled to reasonable attorney’s fees and costs from PROVIDER. K. Relationship of the Parties For purposes of this Agreement, PLAN and PROVIDER are and will act at all times as independent contractors. Nothing in this Agreement shall be construed, or be deemed to create, a relationship of employer or employee or principal and agent, or any relationship other than that of independent entities contracting with each other for the purposes of effectuating this Agreement. In no way shall PLAN be construed to be providers of Health Services or responsible for the provision of such Health Services. PROVIDER shall be solely responsible to the Covered Individual for treatment and medical care with respect to the provision of Health Services. PROVIDER may freely communicate with Covered Individuals regarding the treatment options available to them, includingmedication treatment options, regardless of benefit coverage limitations. PROVIDER hereby expressly acknowledges its understanding that this Agreement constitutes a contract between PROVIDER and PLAN, that PLAN is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and/or Blue Shield Plans ("Association"), permitting PLAN to use the Blue Cross and/or Blue Shield Service Marks in the state where PLAN is located, and that PLAN is not contracting as the agent of the Association. PROVIDER further acknowledges and agrees that it has not entered into this Agreement based upon representations by any person other than PLAN, and that no person, entity or organization other than PLAN shall be held accountable or liable to PROVIDER for any of PLAN's obligations to PROVIDER created under this Agreement. PROVIDER has no license to use the Blue Cross and/or Blue Shield names, symbols, or derivative marks (the "Brands") and nothing in the Agreement shall be deemed to grant a license to PROVIDER to use the Brands. Any references to the Brands made by PROVIDER in its own materials are subject to review and approval by PLAN. This section shall not create any additional obligations whatsoever on the part of Plan, other than those obligations created under other provisions of this Agreement.L. Severability In case any one or more of the provisions of this Agreement shall be invalid, illegal, or unenforceable in any respect, the remaining provisions shall be construed liberally in order to effectuate the purposes hereof, and the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby. If one or more provisions of the Agreement are invalid, illegal or unenforceable and an amendment to the Agreement is necessary to maintain its integrity, the parties shall make commercially reasonable efforts to negotiate an City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 7 amendment to this Agreement and any attachments or addenda to this Agreement which could reasonably be construed not to contravene such statute, regulation, or interpretation. In addition, if such invalid, unenforceable or materially affected provision(s) may be severed from this Agreement and/or attachments or addenda to this Agreement without materially affecting the parties' intent when this Agreement was executed, then such provision(s) shall be severed rather than terminating the Agreement or any attachments or addenda to this Agreement. M. Remittance InformationThe IGT-funded payments made by the PLAN pursuant only to this Agreement, shall be mailed to the PROVIDER at the address set forth below: Allison Narramore, Administrative Officer (for Fire’s Finance Administrative Manager) City of Sacramento Fire Department5770 Freeport Blvd., Suite 200 Sacramento, CA 95822-3516 Phone: (916) 808-8065 Email: [email protected] ID: 94-6000410 * Please also provide a copy of an updated W-9 if there are any changes from the previous W-9 provided N. Term The term of this Agreement shall commence on January 1, 2022 and shall terminate on December 31, 2025.
City of Sacramento Fire Department and Anthem Blue Cross Health Plan-Provider Agreement 2022 Rate Range IGTs 8 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed personally or by their duly authorized officers or agents. SIGNATURESANTHEM BLUE CROSS CITY OF SACRAMENTO VIA ITS FIRE DEPARTMENT Signature: Signature: Name:John Pickett Name: Howard Chan Title: Regional Vice President, Provider Solutions Title: City Manager Date: Date:Approved as to Form: Date: Gary P. Lindsey, Jr., Senior Deputy City Attorney, City of Sacramento Attest By: Date: Wendy Klock-Johnson, Assistant City Clerk, City of Sacramento