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 |
|
|
Debra
Baetz (714) 834-2830 |
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Subject: Intergovernmental
Transfer Opportunity to Support Public Health Initiatives
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:
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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):
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. |
2. |
Authorize the Health Care Agency
Director or designee to execute the final Agreement referenced in Recommended
Action No. 1. |
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:
Board Date |
IGT Participation Periods |
April 26, 2016 |
Fiscal Year:
2014-15 |
May 9, 2017 |
Fiscal Years:
2015-16, 2016-17 |
July 17, 2018 |
Fiscal Year:
2017-18 |
July 16, 2019 |
Fiscal Year:
2019-20 |
October 6, 2020 |
Period: July 1,
2019 - December 31, 2020 |
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