Title
Authorize the Deputy Purchasing Agent of NMC to execute a Health Plan-Provider Agreement with the Fresno-Kings-Madera Regional Health Authority dba CalViva Health, a Medi-Cal Managed Care Plan ("CalViva") to provide for Medi-Cal managed care rate payment increases to NMC for healthcare services rendered in the period of July 1, 2018 to June 30, 2019, to CalViva's Medi-Cal managed care enrollees.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Authorize the Deputy Purchasing Agent of NMC to execute a Health Plan-Provider Agreement with the Fresno-Kings-Madera Regional Health Authority dba CalViva Health, a Medi-Cal Managed Care Plan ("CalViva") to provide for Medi-Cal managed care rate payment increases to NMC for healthcare services rendered in the period of July 1, 2018 to June 30, 2019, to CalViva's Medi-Cal managed care enrollees.
SUMMARY/DISCUSSION:
DHCS administers the Medi-Cal program, under which health care services are provided to qualified low-income persons. Inpatient and outpatient hospital services are a covered benefit under the Medi-Cal program, subject to utilization controls. Existing law provides for Medi-Cal payments to hospitals.
An IGT is an elective transfer of eligible local dollars to the State DHCS in support of the Medi-Cal program, which is authorized in accordance with Section 14164 and other provisions of the Welfare and Institutions Code that are typically program specific. If the State accepts the transfer, the State shall obtain Federal Financial Participation ("FFP") to the full extent permitted by federal law.
In the past, NMC has voluntarily provided IGTs to DHCS in support of the Medi-Cal managed care program as authorized pursuant to Section 14301.4 of the Welfare and Institutions Code. The local fund transfers are effectuated pursuant to an IGT agreement (and an IGT fee assessment agreement if applicable) between the State DHCS and the participating public provider/entity. The opport...
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