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Agenda Item
ASR
Control 23-000912 |
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MEETING
DATE: |
12/05/23 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
All
Districts |
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SUBMITTING Agency/Department: |
Health
Care Agency (Approved) |
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Department contact person(s): |
Regina
Chinsio-Kwong (714) 834-2729 |
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Debra
Baetz (714) 834-2830 |
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Subject: Intergovernmental Transfer
Opportunity to Support Public Health Initiatives
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ceo CONCUR |
County Counsel Review |
Clerk of the Board |
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Concur |
Approved
Agreement to Form |
Discussion |
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3
Votes Board Majority |
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Budgeted: Yes |
Current Year
Cost: $4,000,000 |
Annual Cost: N/A |
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Staffing Impact: |
No |
# of Positions: |
Sole Source: No |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: 12/7/2021 #15, 10/6/2020 #11,
7/16/2019 #12, 7/17/2018 #21 |
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RECOMMENDED
ACTION(S):
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1. |
Approve the Intergovernmental Agreement
Regarding Transfer of Public Funds with the California Department of Health
Care Services for the transfer of approximately $4,000,000 from the Health
Care Agency to the California Department of Health Care Services. |
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2. |
Authorize the Health Care Agency
Director or designee to execute the final Agreement referenced in Recommended
Action No. 1. |
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3. |
Direct the Auditor-Controller, upon
notification from the Health Care Agency Director or designee to issue
payments as required for the Intergovernmental Transfer. |
SUMMARY:
Approval to participate in an
Intergovernmental Transfer will result in federal reimbursement for
uncompensated health care provided to Medi-Cal patients.
BACKGROUND
INFORMATION:
Rate range Intergovernmental
Transfers (IGT) began statewide in 2006 and have been used by other counties in
California to offset the cost of uncompensated health care provided by county
health departments, public hospitals and other local care providers. The
federal Centers for Medicare and Medicaid Services (CMS) provides a rate range
for Medi-Cal managed care services, but the actual reimbursement rates that
plans receive are set by the California Department of Health Care Services
(DHCS). The difference between the federal allowable rate and state actual rate
represents the potential amount of federal reimbursement that counties can
claim through a rate range IGT. The Health Care Agency (HCA) was invited by the
Orange County Health Authority dba CalOptima (CalOptima) to participate in an
IGT to obtain federal reimbursement for uncompensated health care provided to
their patients during the service period of January 1, 2022, to December 31,
2022. The reimbursement by CMS is a dollar-for-dollar match of non-federal
funds, which combined covers the cost of eligible healthcare expenditures
incurred. In this instance, the net proceeds are shared between CalOptima and
HCA. HCA plans to return to your Honorable Board of Supervisors (Board) for
approval of the corresponding Agreement with CalOptima related to this IGT once
the Agreement with DHCS is finalized.
CalOptima, in collaboration with
the University of California, Irvine Medical Center, has participated in IGTs
since FY 2010-11. To optimize Orange County's drawdown of federal funds,
CalOptima extended the IGT opportunity to HCA beginning with FY 2014-15. The
Board approved HCA's participation in these IGTs for the following periods:
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Board
Date |
IGT
Participation Periods |
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April 26, 2016 |
Fiscal Year:
2014-15 |
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May 9, 2017 |
Fiscal Years:
2015-16, 2016-17 |
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July 17, 2018 |
Fiscal Year:
2017-18 |
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July 16, 2019 |
Fiscal Year:
2019-20 |
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October 6, 2020 |
Period: July 1,
2019 - December 31, 2020 |
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December 7, 2021 |
Period: January
1, 2021, to December 31, 2021 |
Pending the Board's approval, in FY
2023-24, HCA will transfer the investment amount determined by CalOptima and
currently estimated to be $4 million (HCA's original investment) to DHCS. Upon
receipt, DHCS will draw down available federal matching funds from CMS and
transfer the full match to CalOptima. CalOptima will return HCA's original
investment and then CalOptima and HCA will split the federal matching funds.
HCA estimates an additional $7 million in federal matching funds above the
original investment of $4 million for a total return of approximately $11
million.
Because this federal funding is
intended to offset Public Health expenditures, all funds received by both
CalOptima and HCA will be used to support Public Health initiatives in Orange
County. CalOptima's portion will be used to support priorities of the Orange
County Health Improvement Plan that are consistent with their strategic
priorities, such as improving access to medical and behavioral health care and
improving children’s health, particularly around reducing obesity. Funds
received by HCA will offset net County costs to support Public Health Services
that promote health and prevent the spread of communicable diseases.
HCA requests approval of the IGT Agreement
with DHCS and associated actions referenced in the Recommended Actions.
FINANCIAL
IMPACT:
Appropriations and revenue related
to this IGT are included in Budget Control 042 FY 2023-24 budget.
The transfer amount of
approximately $4 million in General Funds in FY 2023-24 will be returned with
the estimated $7 million in federal matching funds for a total return of $11
million. Based on prior history, it is estimated that the funds will be
returned within 90 days of transfer.
STAFFING
IMPACT:
N/A
ATTACHMENT(S):
Attachment
A - Intergovernmental Transfer Agreement