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HomeMy WebLinkAboutAgreement A-15-062 with County of Plumas.pdfMAA1415FRESNO AGREEMENT Between the COUNTY OF PLUMAS and COUNTY OF FRESNO AGREEMENT NO. 15-062 PAGE 1 OF 11 THIS AGREEMENT is made and entered into by and between COUNTY OF FRESNO , a political subdivision of the State of California, hereinafter referred to as "LOCAL GOVERNMENTAL AGENCY (LGA)" and the COUNTY OF PLUMAS, a political subdivision of the State of California, hereinafter referred to as "HOST ENTITY." WITNESSETH: WHEREAS , LGA desires to extend health services to local residents, through the provision of County-Based Medi-Cal Administrative Activities (CMAA) and/or Targeted Case Management (TCM), by contracting with HOST ENTITY; and WHEREAS, LGA is prepared to provide health services to its local residents under the terms and conditions set forth in this AGREEMENT and Exhibit A concerning County-Based Medi-Cal Administrative Activities (CMAA) or Targeted Case Management (TCM) which is part of this AGREEMENT ; and WHEREAS, LGA desires to extend School-based health services to local education agencies, through the provisions of School-Based Medi-Cal Administrative Activities (SMAA) by contracting with HOST ENTITY as an addendum or amendment to this contract as it applies; and WHEREAS, LGA is prepared to provide school-based health services to its local education agencies under the terms and conditions set forth in this AGREEMENT as an addendum or amendment to this agreement as it applies ; and WHEREAS , HOST ENTITY was selected by LGA Consortium to collect and disburse LGA participation fees; and WHEREAS, the Plumas County Board of Supervisors has authorized entering into this Agreement as HOST ENTITY; and WHEREAS, the authorizing entity o f LGA has authorized entering into this AGREEMENT; NOW, THEREFORE, IT IS MUTUALLY AGREED AS FOLLOWS: I. HOST ENTITY , Responsibilities : HOST ENTITY shall perform duties listed in attached Exhibit A. II. LGA Responsibilitie~: LGA shall perform duties listed in attached Exhibit A concerning County Based MAA and/or TCM. III . LGA Responsibilities: LGA shall perform duties listed as an addendum or amendment concerning School-Based MAA. IV. HOST ENTITY is the "Administrative Hub" for the purpose of performing the requirements of the SMAA LGA program as applicable to the LGA, as described in the terms of this Agreement . In return for this administrative hub responsibility, HOST ENTITY will receive a total annual compensation in accordance with the Consortium's Bylaws, to be paid from the MAA/TCM trust fund . MAA1415 PAGE 2 OF 11 V. HOST ENTITY is the "host entity" only for the purposes of collecting and disbursing funds for the Medi-Cal Administrative Activities (MAA) and Targeted Case Management (TCM) trust fund, as described in the terms of this Agreement. In return for this host entity responsibility, HOST ENTITY will receive a total annual compensation in accordance with the Consortium's Bylaws, to be paid from the MANTCM trust fund. VI. With the exception of Plumas County claims, HOST ENTITY will not be responsible for producing claims, amending data or providing other materials related to LGA , as required by the State, to process LGA County-based MAA (CMAA), School-based MAA (SMAA), Mental Health MAA (MHMAA) or TCM claims . Additionally, HOST ENTITY will not be fmancially responsible for paying any participation fee or other costs for any LGA which has failed to pay the total amount of its fee in a timely manner. VII. With the exception of audit exceptions arising from Plumas County claims, HOST ENTITY will not be fmancially responsible for any audit exceptions. HOST ENTITY will comply with all applicable laws and regulations governing the use ofMAA and TCM trust funds and public funds, generally, in the collection and disbursement of funds for the MAA and TCM trust fund pursuant to the terms of this Agreement VIII. Insurance and Indemnification: Each of the parties ofthis Agreement is an entity which is self-insured and/or carries liability insurance. Each party will provide liability coverage for its negligent or intentionally wrongful acts and/or omissions in the performance of its duties under this Agreement. The parties hereto shall indemnify, defend and hold one another, their officers, agents and employees harmless from and against any and all claims, losses, liabilities, damages, demands and actions (all collectively referred to as "liability" herein) arising out of each parties' respective performance of this Agreement, but only in proportion to and to the extent such liabilities are caused by or result from the negligent or intentionally wrongful act or omission of the indemnifying party, its officers, agents or employees. IX. Termination: LGA may give notice of its intent to terminate this Agreement, and accordingly its membership in the LGA Consortium, at any time. Following the effective date ofLGA's termination, the LGA will not participate in any further LGA Consortium activities. The effective date oftermination is concurrent with the LGA's fmal MAA and/or TCM payments. Participation fees will continue to be calculated and payable to the Host Entity for all reimbursements received by LGA after LGA' s notice of intent to . terminate. LGAs receiving MAA and/or TCM payments which fail to pay the calculated participation fees will be in breach of this Agreement. X. Effective Date of AGREEMENT: This AGREEMENT will be effective upon Execution by HOST ENTITY and LGA for the period beginning July 1, 2014 ending June 30, 2015 . XI. The maximum amount payable by LGA to HOST ENTITY under this AGREEMENT is twelve thousand five hundred twenty-five dollars ($12,525). Upon termination ofthis AGREEMENT and payment by LGA to HOST ENTITY, LGA will be considered to have left the LGA Consortium as a member in good standing. XII. Extent of Contractual Documents: This AGREEMENT shall consist ofthis basic document, Exhibit A, "Agreement Concerning Medi-Cal Administrative Activities/Targeted Case Management" and Exhibit B, "Payment and Fee Schedule", attached hereto and incorporated into this AGREEMENT. Applicable for SMAA participation, Exhibit C "Addendum For LGAs with SMAA Program", Exhibit D "SMAA Fee Structure", Appendix A "PCG License Agreement , and Appendix B MAA1415 PAGE30Fll "Fairbanks Coding Services Agreement", attached hereto and incorporated into this AGREEMENT. "HOST ENTITY" Duly Authorized COUNTY OF PLUMAS I \ By~= MimlHal)l)ifector Public Health Agency 270 County Hospital Road, Suite 206 Quincy~ California 95971 "LGA" Duly Authorized B Deborah Poochigian County of Fresno 2281 Tulare Street, Room 300 Fresno, CA 93721 ATIEST: BERNICE E. SEIDEL, Clerk Boatll of Supervisors By ~sA.,'A ~ .S0t'\'if\ Deputy LGA Host Co Agreement between Co of Plumas & Co of Fresno July 1, 2014 through June 30, 2015 1 IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and 2 year first hereinabove written: 3 ATTEST: 4 5 6 BERNICE E. SEIDEL, Clerk Board of Supervisors 7 By ~s.fu!\. b~cr?-twutt 8 9 10 11 12 13 14 15 16 APPROVED AS TO LEGAL FORM: DANIEL CEDERBORG, COUNTY COUNSEL APPROVED AS TO ACCOUNTING FORM: COUNTY OF FRESNO By ~~LL~~~--~~--~~~ Chairman, Board of Supervisor REVIEWED AND RECOMMENDED FOR APPROVAL: By j)~L-~ Vicki Crow, C.P.A., Auditor-Controller/ Treasurer-Tax Collector 17 VICKI CROW, C.P.A., AUDITOR-CONTROLLER/ TREASURER-TAX COLLECTOR 18 19 20 21 22 23 24 25 26 Fund/Subclass: 27 Organization: 28 Account: 0001110000 0410 7250 3a of 11 COUNTY OF FRESNO Fresno, CA MAA1415 PAGE 4 OF 11 DEFINITIONS 1. Local Government Agency (LGA) -A local public health office or county agency in a county or chartered city that oversees the MAA and TCM programs. 2. LGA Consortium-A collaboration ofLGA MAA/TCM Coordinators and /or designees who meet regularly and pursue the proper and efficient administration ofthe MAA and TCM Programs. 3. Executive Committee-A team of elected members ofthe LGA Consortium who meet regularly and are responsible for the executive management of the LGA Consortium. Duties include, but are not limited to, the review of fiscal revenue and expenditure reports; the approval of the annual budget; and the approval of payments by the LGA Consortium. 4. Membership -All California county and/or chartered city Coordinators or designees are eligible to join the Consortium and serve as their LGA representative. Membership is contingent on the annual payment of participation fees. 5. HOST ENTITY-The local governmental agency designated by all local governmental agencies participating in the MAA/TCM program, to be the administrative and fiscal intermediary between the department and all participating local governmental agencies. 6. Participation Fee-Payment to the LGA Consortium for the Consortium 's MAA/TCM administrative costs and the costs of the California State Department ofHealth Care Services (DHCS). Payment amounts will be determined based on percentage of revenue received by each program in which the LGA participates. The rate will be incremental over the two-year period of the current contract and it will be reviewed and reassessed annually, thereafter. Participations fees are due until fmal MAA and/or TCM payments . 7. Termination-To discontinue or cancel an active membership, contract or agreement. Acceptable notice of intent to terminate an active membership must have an effective date that is concurrent with any fmal MAA and/or TCM payments. All fees are due and payable during this time. MAA1415 PAGE 5 OF 11 EXHIBIT A: Scope of Work AGREEMENT CONCERNING MEDI-CAL ADMIINSTRATIVE ACTIVITIES/TARGETED CASE MANAGEMENT HOST ENTITY will: 1. Prepare and transmit Host Entity/LGA AGREEMENT and Participation Fee invoice to the LGA in the amount identified pursuant to Exhibit B, due and payable immediately for the fiscal year 2014/2015. 2. Maintain Medi-Cal Administrative Activities (MAA) Targeted Case Management (TCM) Trust Fund solely for the purpose of maintaining and accounting for funds received from LGA participation fees. 3. Enter into a separate agreement with the State Department of Health Care Services to coordinate administration of the MAA/TCM programs on behalf of the LGAs. 4. Pay the California State Department ofHealth Care Services (DHCS) for FY 2014/2015 and FY 2015/2016 MAAITCM administrative costs pursuant to the agreement between DHCS and HOST ENTITY and as agreed to by the LGA Consortium, within sixty (60) days ofExecutive Committee Approval of the State's invoices for reimbursement of documented costs incurred by DHCS. 5. Pay the MAA/TCM LGA consultant ofFY 2014 /2 015 and 2015 /2 016 costs pursuant to the contract between LGA consultant and HOST ENTITY and as agreed to by LGA Consortium, within twenty-one (21) days ofExecutive Committee approval of invoices submitted by the MAA/TCM LGA Consultant. 6. Manage and oversee all procurement activities on behalf of the Consortium, including consulting services, School-based MAA (SMAA) vendors, etc . 7. Provide to Executive Committee for review quarterly revenue and expenditure reports. 8. Develop and Submit to Executive Committee an annual budget, including information about all fees assessed and received. Annual budget will be provided to the LGA Consortium for review. 9. Pay all expenses incurred by HOST ENTITY, including costs related to coordinating the Annual MAA/TCM Conference. 10. Carry out other duties and responsibilities as defmed and delineated in the LGA Consortium by-laws. MAA1415 PAGE 6 OF 11 LGA will: 1. Pay MAA/TCM Participation Fee to HOST ENTITY by October 31, 2014 for FY 2014/2015 or immediately upon receipt of invoice, whichever is later. 2. Assume fiscal responsibility for all MAA/TCM claims ofLGA, including any audit exceptions. 3. Assume responsibility for producing claims, amending data or providing other materials necessary to process LGA MAA or TCM claim. 4. Carry out other duties and responsibilities as defmed and delineated in the LGA Consortium by-laws. MAA1415 PAGE 7 OF 11 EXHIBIT B: Payment and Fee Structure 1. Initial Membership Fee: The LGA will pay $500 to join or reinstate membership into th e LGA Consortium. This initial membership fee will onl y cover LGA Co nsortium expenses. Any LGA requesting reinstatement that left the Consortium in bad standin g will be required to pay the balance of its outstanding participation fee s plu s int eres t plus penalties as determined by the LGA Consortium Executive Co mmittee . 2. Ongoing Participation Fee : Fees will be determined based on percentage of revenue received by each program in which the LGA participates. The rate will be as follows for 2014-2015. The participation fee will be reviewed and reassessed every year thereafter, subject to the actual DHCS expenses invoiced to the LGA consortium. Fiscal Year 2014-2015 a. Each LGA will be assessed 1. 1.5% of its County based Medi-Cal Administrative Activities (CMAA) payments issued by DHCS during July 1 -June 30 of the prior fiscal year plus 11. 1.5 %of it School Based Medi-Cal Administrative Activities (SMAA) payments issued by DHCS during July 1 -June 30 of the prior fiscal year plus 111. 1.5 % of its Targeted Case Management (TCM) payments issued by DHCS during July 1 -June 30 of the prior fiscal year plus IV. .75% of its Mental Health Medi-Cal Administrative Activities (MHMAA) payments 3. The payments will be calculated by the HOST ENTITY and further re v iewed by th e LGA Executive Committee and LGA Consultant based on figures provided by DH CS acco unt s payable . 4. There will be no offsets to the participation fee. Participation fees will not change because of any adverse reimbursement impacts suffered by an LGA due to any audit exemptions. 5. LGAs are responsible for payment of fees for every year in which MANTCM revenue is claimed and/or received (refer to Termination Clause) with the exception ofSchool-MAA deferred revenue received . MAA1415 PAGE 8 OF 11 EXHIBIT C: Scope of Work ADDENDUM FOR LGAs WITH SCHOOL BASED MEDI-CAL ADMINISTRATIVE ACTIVITIES PROGRAM AGREEMENT CONCERNING SCHOOL-BASED MEDI-CAL ADMINISTRATIVE ACTIVITIES HOST ENTITY will participate in: • Training regarding RMTS o Ensure claiming unit has participated in required RMTS training; o Review ofRMTS compliance rate; ensure each claiming unit meets the minimum 85% compliance level requirement; o Ensure claiming unit coordinator understands how critical response rate is per claiming unit and that the claiming unit is aware of non-compliance consequences. • Roster Updates o Receive electronic updated roster from claiming unit; o Review updated roster to validate TSPs are accurately placed in the correct cost pools; o Ensure that the individual claiming unit rosters are uploaded quarterly into a database with all other participating claiming units. o Time Study Tasks o Randomly select TSPs from the Participant Universe of eligible participants and assign each TSP to an individual moment from the pool of eligible moments to establish a Master Moments list; o Maintain confidentiality of Master Moment List; o Notify selected TSPs no sooner than five student attendance days prior to their selected moment and on the day of the moment; o Review TSP responses to the random moment questions and assign MAA codes; o Pose clarifying questions to TSPs if necessary for the determination ofthe appropriate time study code; o Quality check coded time study data; o Follow up with participants who submitted incomplete samples; o Review all data and prepare it for the claim. o Financial Tasks o Conduct fmancial training with claiming units, as needed; o Maintain all source documentation; o If necessary, resubmit to contact for revisions; o Receive completed CPE forms from district and submit to DHCS. o Contract directly with Software Solution Provider (SSP) and Coding Vendor to implement the RMTS program on behalf ofthe SMAA Collaborative. o Miscellaneous Tasks o Participate in LECILGA and DHCS Advisory Committee meetings; MAA1415 PAGE 9 OF 11 o Answer general questions from claiming units throughout the quarter; LGA will: o Submit quarterly MAA claims on behalf of the SMAA Collaborative members to DHCS; o Conduct quality RMTS Program assurance reviews, as needed; o Serve as liaison between claiming units and DHCS. Each claiming unit participating in the MAA program must take appropriate oversight and monitoring actions that will ensure compliance with MAA program requirements. Actions must be taken to ensure, at a minimum, that: • The time study is performed according to DHCS guidelines and requirements; • The time study responses are completed in the required timeline ; • The fmancial data submitted is true and correct ; • RMTS participant training requirements are met ; • Appropriate documentation is maintained to support the time study and the claim. Roster Updates • Prepare and submit updated electronic rosters and email to LEC/LGA as required. Failure to provide this information in the time frame allowed will result in the claiming unit not being able to participate for that quarter. Financial Tasks • Prepare fmancial information for the MAA claim; • Prepare Certification of Public Expenditure (CPE) form and send to fmancial contact for submission; • Collect annual indirect cost rate (ICR) from the CDE; • Obtain Medi-Cal Percentage (MP) (Semiannually). LGA shall comply with the PCG License Agreement for PCG 's proprietary software in accordance with the license agreement attached hereto as Appendix A and incorporated herein by reference . Required Personnel Each claiming unit must designate a claiming unit emplo yee as the claiming unit's coordinator or MAA program contact. This single individual is designated within the claiming unit to provide oversight for the implementation of the time study and to ensure that policy decisions are implemented appropriately . The claiming unit coordinator cannot be affiliated with or employed by a consultant/consulting firm or vendor. MAA1415 PAGE 10 OF 11 INCLUDED WITH ADDENDUM OR AMENDMENT: EXHIBIT D: SMAA FEE STRUCTURE FOR RMTS AND CODING SERVICES 1. RMTS SOFTWARE FEE: The RMTS software is contracted with PCG for FY14/15 beginning July 1, 2014 to June 30 , 2015 in the total amount not to exceed $223,958 or $8.50 per participants as long as the quarterly count of participants is 5 ,000+ per quarter or $10.50 if is below 5,000 per quarter. PCG will send an invoice to the administrative hub for payment on a quarterly basis after LGA has received payments on the quarterly claims from DHCS as long as it is done on a timely manner. Payments to PCG for services are due 30 days from invoice date. Pricing is based on approved methodology, including 2 Cost pools and will conduct one RMTS per quarter. Each LGA will be assessed a fee as calculated on Exhibit D. The RMTS Software services pricing is inclusive of all related project costs including but not limited to travel and training , system design, and implementation, incidental expenses, overhead costs, and status meetings. Fees include: 1. All system hosting and maintenance fee -PCG will configure the RMTS system to meet DHCS /CMS requirement 2. Advanced reporting module to create ad-hoc reports-All existing reports in the RMTS are included in the pricing. All required reports by DHCS are included in system fees. In the event the County requests additional reports , development rate of $150/hour will apply. 3. Periodic system enhancements and features such as dashboard reporting and unique participant email log in link 4. Help desk support (email and toll free phone) to LGA, LEA SMAA coordinators and participants 5. Year 1 training a. Implementation training (8 days onsite) 1. LGA/Host County 11. LEA SMAA coordinator 111. Coder Training IV. Webinar 6. Trainings conducted by webinar will be recorded and provided electronically for later playback. Link to trainings will be added to sy stem dashboard. In addition, LGAs can post link to other location. 7. Additional onsite trainings can be provided at $2 ,000 /day. APPENDIX A PCG RMTS LICENSE AGREEMENT APPENDIX B FAIRBANKS CODING SERVICES AGREEMENT Fairbanks will provide the full scope of Centralized Coder Services in accordance with agreed pricing. The services that are included in the fee are: • Contractor shall employ a minimum of three (3) professional staff for the contract. MAA1415 PAGE 11 OF 11 • Central coding staff shall be required to attend annual training provided by DHCS • All coding shall be consistent with the California SMAA manual and implementation Plan and adhere to all State approved activity codes. • The RMTS administrator shall send a monthly report of all coding discrepancies to the Count identifYing the LEA, the claiming unit and the participant name as well as the specific coded moment. • Contractor shall submit a monthly report of the number of moments coded per LEA. • Contractor shall submit a monthly labor report per coder detailing increments of their time. • The RMTS system shall randomly select , at a minimum, 10% of all coded moments each quarter or quality assurance code review by the LGA. • Contractor shall develop and submit to the County, a written Quality Assurance (QA) Plan thirty days after contract execution and thirty days after each annual contract renewal date thereafter. Annual Centralized coder fee: $41 , 240.00 Quarterly Centralized coder fee: $1 0 ,312 The Fairbanks fee is deducted by the LGA from the quarterly remittances ofSMAA reimbursement to LEAs and therefore is paid after Federal funds have been received as long as the MAA invoices are processed and submitted to DHCS by LGA on a timely manner.