HomeMy WebLinkAboutAgreement A-21-181 with California Dept. of Health Care Services.pdfMEDI-CAL COUNTY INMATE PROGRAM
CERTIFICATION OF VOLUNTARY CONTRIBUTIONS
A g reeme nt No . 2 1-18 1
TO NON-FEDERAL SHARE OF MEDICAID EXPENDITURES
On behalf of County of Fresno (the Governmental Funding Entity), I hereby
certify that the intergovernmental transfer amount specified herein represents a voluntary
contribution by the Governmental Funding Entity to the non-federal share of Medicaid
expendituresforpurposesof all federal laws , including, but not limited to Section
10201 (c)(6) of the Patient Protection and Affordable Care Act (Public Law No. 111-148).
The funds transferred qualify for Federal Financial Participation (FFP) pursuant to 42
C .F.R . part 433, subpart B , and are not derived from impermissible sources . Govern-
mental Funding Entity shall indemnify DHCS for any deferral or disallowance of FFP
should funds transferred pursuant to this certification be deemed ineligible for FFP.
This voluntary contribution in the amount of $ 134,778.00 is intended to fulfill the
Governmental Funding Entity's responsibility for the non-federal share of certain
payments under the Medi-Cal County Inmate Program (MCIP) implemented in
accordance with California Welfare and Institutions Code (WIC) Section 14053 .7 and
14053.8.
These funds are provided solely to enable DHCS to obtain FFP for MCIP payments as
permitted by federal law. In the event DHCS is unable to obtain FFP for these MCIP
payments , or the full MCIP payments cannot otherwise be made to and retained by hos-
pital providers of acute inpatient services under the MCIP, and therefore all or a portion
of the transferred amount cannot be used as intended , DHCS will notify the Govern-
mental Funding Entity and return the applicable portion of the unused intergovernmental
transfer amount. Amounts due to or owed by the Governmental Funding Entity may be
offset against future transfers related to MCIP as determined by DHCS . The govern-
mental fund ing entity may not receive and retain any of the Medicaid payments funded
by the IGT funds.
All records of public funds constituting the non-federal share are subject to review and
audit by DHCS . The Governmental Funding Entity understands that DHCS must deny
payment under WIC sections14053 .7 , 14053 .8 , and Penal Code 5072 if it is determined
that the IGT, the certification, or both is not adequately supported for purposes of claim-
ing FFP.
I am authorized to sign this certification of voluntary contributions on behalf of the Gov-
ernmental Funding Entity. I understand that knowingly filing a false or fraudulent state-
ment in support of a claim may violate the Federal False Claim Act or other applicable
statute , JCble thereunder.
Steve Brandau, Chairman of the Board of Supervisors of the County of Fresno
Attest:
Bernice E. Seidel, Clerk of the Board of Supervisors , County of Fresno , State of California