HomeMy WebLinkAboutAgreement A-25-345 IGT Agreement with DHCS.pdf Agreement No. 25-345
CONTRACT#IGT-24-0032
INTERGOVERNMENTAL AGREEMENT REGARDING
TRANSFER OF PUBLIC FUNDS
This Agreement is entered into between the CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES ("DHCS") and COUNTY OF FRESNO DEPARTMENT OF
PUBLIC HEALTH ("GOVERNMENTAL FUNDING ENTITY")with respect to the matters set
forth below.
The parties agree as follows:
AGREEMENT
1. Transfer of Public Funds
1.1 The GOVERNMENTAL FUNDING ENTITY agrees to make a transfer
of funds to DHCS pursuant to sections 14164 and 14301.4 of the Welfare and Institutions Code.
The amount transferred shall be based on the sum of the applicable rate category per member per
month("PMPM") contribution increments multiplied by member months, as reflected in Exhibit
1. The GOVERNMENTAL FUNDING ENTITY agrees to initially transfer amounts that are
calculated using the Estimated Member Months in Exhibit 1, which will be reconciled to actual
enrollment for the service period of January 1, 2024 through December 31, 2024 in accordance
with Sub-Section 1.3 of this Agreement. The funds transferred shall be used as described in Sub-
Section 2.2 of this Agreement. The funds shall be transferred in accordance with the terms and
conditions, including schedule and amount, established by DHCS.
1.2 The GOVERNMENTAL FUNDING ENTITY shall certify that the funds
transferred qualify for Federal Financial Participation pursuant to 42 C.F.R. part 433, subpart B,
and are not derived from impermissible sources such as recycled Medicaid payments, Federal
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money excluded from use as State match, impermissible taxes, and non-bona fide provider-
related donations. Impermissible sources do not include patient care or other revenue received
from programs such as Medicare or Medicaid to the extent that the program revenue is not
obligated to the State as the source of funding.
1.3 DHCS shall reconcile the "Estimated Member Months," in Exhibit 1, to
actual enrollment in HEALTH PLAN(S) for the service period of January 1, 2024 through
December 31, 2024 using actual enrollment figures taken from DHCS records. Enrollment
reconciliation will occur on an ongoing basis as updated enrollment figures become available.
Actual enrollment figures will be considered final two years after December 31, 2024. If
reconciliation results in an increase to the total amount necessary to fund the nonfederal share of
the payments described in Sub-Section 2.2, the GOVERNMENTAL FUNDING ENTITY agrees
to transfer any additional funds necessary to cover the difference. If reconciliation results in a
decrease to the total amount necessary to fund the nonfederal share of the payments described in
Sub-Section 2.2, DHCS agrees to return the unexpended funds to the GOVERNMENTAL
FUNDING ENTITY. If DHCS and the GOVERNMENTAL FUNDING ENTITY mutually
agree, amounts due to or owed by the GOVERNMENTAL FUNDING ENTITY may be offset
against future transfers.
2. Acceptance and Use of Transferred Funds
2.1 DHCS shall exercise its authority under section 14164 of the Welfare and
Institutions Code to accept funds transferred by the GOVERNMENTAL FUNDING ENTITY
pursuant to this Agreement as Intergovernmental Transfer(IGTs), to use for the purpose set forth
in Sub-Section 2.2.
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2.2 The funds transferred by the GOVERNMENTAL FUNDING ENTITY
pursuant to Section 1 and Exhibit 1 of this Agreement shall be used to fund the non-federal share
of Medi-Cal Managed Care actuarially sound capitation rates described in section 14301.4(b)(4)
of the Welfare and Institutions Code as reflected in the contribution PMPM and rate categories
reflected in Exhibit 1. The funds transferred shall be paid, together with the related Federal
Financial Participation,by DHCS to HEALTH PLAN(S) as part of HEALTH PLAN(S)'
capitation rates for the service period of January 1, 2024 through December 31, 2024, in
accordance with section 14301.4 of the Welfare and Institutions Code.
2.3 DHCS shall seek Federal Financial Participation for the capitation rates
specified in Sub-Section 2.2 to the full extent permitted by federal law.
2.4 The parties acknowledge that DHCS will obtain any necessary approvals
from the Centers for Medicare and Medicaid Services.
2.5 DHCS shall not direct HEALTH PLAN(S)' expenditure of the payments
received pursuant to Sub-Section 2.2.
3. Assessment Fee
3.1 DHCS shall exercise its authority under section 14301.4 of the Welfare
and Institutions Code to assess a 20 percent fee related to the amounts transferred pursuant to
Section 1 of this Agreement, except as provided in Sub-Section 3.2. GOVERNMENTAL
FUNDING ENTITY agrees to pay the full amount of that assessment in addition to the funds
transferred pursuant to Section 1 of this Agreement.
3.2 The 20-percent assessment fee shall not be applied to any portion of funds
transferred pursuant to Section 1 that are exempt in accordance with sections 14301.4(d) or
14301.5(b)(4) of the Welfare and Institutions Code. DHCS shall have sole discretion to
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determine the amount of the funds transferred pursuant to Section 1 that will not be subject to a
20 percent fee. DHCS has determined that $0.00 of the transfer amounts will not be assessed a
20 percent fee, subject to Sub-Section 3.3.
3.3 The 20-percent assessment fee pursuant to this Agreement is non-
refundable and shall be wired to DHCS simultaneously with the transfer amounts made under
Section 1 of this Agreement. If at the time of the reconciliation performed pursuant to Sub-
Section 1.3 of this Agreement, there is a change in the amount transferred that is subject to the
20-percent assessment in accordance with Sub-Section 3.1, then a proportional adjustment to the
assessment fee will be made.
4. Amendments
4.1 No amendment or modification to this Agreement shall be binding on
either party unless made in writing and executed by both parties.
4.2 The parties shall negotiate in good faith to amend this Agreement as
necessary and appropriate to implement the requirements set forth in Section 2 of this
Agreement.
5. Notices. Any and all notices required,permitted, or desired to be given hereunder
by one parry to the other shall either be sent via secure email or submitted in writing to the other
parry personally or by United States First Class, Certified or Registered mail with postage
prepaid, addressed to the other party at the address as set forth below:
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To the GOVERNMENTAL FUNDING ENTITY:
Joe Prado, Assist. Dir.
1221 Fulton Street
Fresno, CA 93720
(559) 600-6402
jprado&fresnocoun . ca.gov
With copies to:
Irene Parada, Finance Div. Mgr.
1221 Fulton Street
Fresno, CA 93721
(559) 600-6438
iparadakfresnocountyca.gov
To DHCS:
Vivian Beeck
California Department of Health Care Services
Capitated Rates Development Division
1501 Capitol Ave., MS 4413
Sacramento, CA 95814
Vivian.BeeckA,dhcs.ca.gov
6. Other Provisions
6.1 This Agreement contains the entire Agreement between the parties with
respect to the Medi-Cal payments described in Sub-Section 2.2 of this Agreement that are funded
by the GOVERNMENTAL FUNDING ENTITY, and supersedes any previous or
contemporaneous oral or written proposals, statements, discussions, negotiations or other
agreements between the GOVERNMENTAL FUNDING ENTITY and DHCS relating to the
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subject matter of this Agreement. This Agreement is not, however, intended to be the sole
agreement between the parties on matters relating to the funding and administration of the Medi-
Cal program. This Agreement shall not modify the terms of any other agreement, existing or
entered into in the future, between the parties.
6.2 The non-enforcement or other waiver of any provision of this Agreement
shall not be construed as a continuing waiver or as a waiver of any other provision of this
Agreement.
6.3 Sections 2 and 3 of this Agreement shall survive the expiration or
termination of this Agreement.
6.4 Nothing in this Agreement is intended to confer any rights or remedies on
any third party, including, without limitation, any provider(s) or groups of providers, or any right
to medical services for any individual(s) or groups of individuals. Accordingly, there shall be no
third parry beneficiary of this Agreement.
6.5 Time is of the essence in this Agreement.
6.6 Each party hereby represents that the person(s) executing this Agreement
on its behalf is duly authorized to do so. Any required signature(s) on any documents must be in
compliance with California Government Code section 16.5 and any other applicable state or
federal regulations.
7. State Authority. Except as expressly provided herein, nothing in this Agreement
shall be construed to limit, restrict, or modify the DHCS' powers, authorities, and duties under
Federal and State law and regulations.
8. Approval. This Agreement is of no force and effect until signed by the parties.
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9. Term. This Agreement shall be effective as of January 1, 2024 and shall expire as
of June 30, 2027 unless terminated earlier by mutual agreement of the parties.
SIGNATURES
IN WITNESS WHEREOF,the parties hereto have executed this Agreement, on
ATTEST:
the date of the last signature below. BERNICE E.SEIDEL
Clerk of the Board of Supervisors
COUNTY OF FRESNO DEPARTMENT OF PUBLIC HEALTH: County of Fresno,State of California
By_ Deputy
By: Date: —8 020o2 5-
Ernest Buddy Mendes, Chairman, Fresno County Board of Supervisors
THE STATE OF CALIFORNIA, DEPARTMENT OF HEALTH CARE SERVICES:
By: Date:
Authorized Representative, Department of Health Care Services
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Exhibit I
Health Plan Funding Entity Rating Region Service Period Participation%
Calvva Health County of Fresno Department of Tri-County 1/2024-12/2024 15.47%
Public Health
Contribution Estimated Member Estimated
Category of Aid SIS/UIS PMPM Months* Contribution(Non-
Federal Share)
Child SIS $ 0.60 2,113,451 $ 1,268,071
Child UIS $ 0.25 66,398 $ 16,600
Adult SIS $ 1.45 735,316 $ 1,066,208
Adult UIS $ 0.77 272,087 $ 209,507
Adult Expansion SIS $ 0.24 1,215,777 $ 291,786
Adult Expansion UIS $ 0.16 229,657 $ 36,745
SPD SIS $ 4.13 264,868 $ 1,093,905
SPD UIS $ 2.67 29,037 $ 77,529
SPD Dual SIS $ 1.17 288,303 $ 337,315
SPD Dual UIS $ 0.39 3,300 $ 1,287
LTC SIS $ 26.38 348 $ 9,180
LTC UIS $ 3.91 454 $ 1,775
LTC Dual SIS $ 19.96 6,632 $ 132,375
LTC Dual UIS $ 0.24 39 $ 9
Est.FETotal 5,225,667 $ 4,542,292
Health Plan Funding Entity Rating Region Service Period Participation%
Anthem Blue Cross County of Fresno Department of Tri-County 1/2024-12/2024 3.84%
Public Health
Contribution Estimated Member Estimated
Category of Aid SIS/UIS PMPM Months* Contribution(Non-
Federal Share)
Child SIS $ 0.14 866,554 $ 121,318
Child UIS $ 0.06 26,672 $ 1,600
Adult SIS $ 0.29 306,360 $ 88,844
Adult UIS $ 0.17 113,136 $ 19,233
Adult Expansion SIS $ 0.06 695,947 $ 41,757
Adult Expansion UIS $ 0.06 94,560 $ 5,674
SPD SIS $ 0.91 126,196 $ 114,838
SPD UIS $ 0.50 14,028 $ 7,014
SPD Dual SIS $ 0.29 250,687 $ 72,699
SPD Dual UIS $ 0.10 2,548 $ 255
LTC SIS $ 6.55 351 $ 2,299
LTC UIS $ 0.97 203 $ 197
LTC Dual SIS $ 4.53 5,398 $ 24,453
LTC Dual JUIS 1 $ 0.06 1 59 1 $ 4
Est.FETotal 2,502,699 1 $ 500,185
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* Note that Estimated Member Months are subject to variation, and the actual total Contribution
(Non-Federal Share)may differ from the amount listed here.
* FMAP is a weighted blend of multiple FMAPs.
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Agreement between the County of Fresno and California Department of Health
Care Services
Name/No.: DHCS IGT Agreement (State Agreement No IGT-24-0032)
Fund/Subclass: 0001/10000
Organization #: 56201500
Account #: 7295