STAFF REPORT - CITY COUNCIL/SUCCESSOR AGENCY/PUBLIC FINANCE AUTHORITY

City Manager and Fire Chief recommend that the City Council approve the Health Management Services Agreement and Cooperative Agreement with Health Management Associates and cities of Dinuba, Kingsburg, Selma, and Sanger for the purposes of assisting with Medi-Cal Rate Range Intergovemmental Transport (IGT) programs and managed care health insurance programs and authorize the City Manager to execute the contract on behalf of the City.

 The purpose of the renewal of this contract is to continue to seek advice and obtain assistance in participating with the managed care systems and Intergovernmental Transport (IGT) programs that are available to the Fire Department's ambulance program. The Medi-Cal Rate Range IGT program is a program available to fire departments that provide ambulance transport to receiving hospitals for reimbursement from unpaid claims from State-managed healthcare plans. It will be the responsibility of HMA to provide very detailed work with the various health care plans, the Department of Health Care Services and the Fire Departments and assist with the production of data and forms relative to the program. This will be a joint venture with the Fire Departments in Selma, Kingsburg, Sanger and Dinuba and costs for HMA's services will be split equally among the Departments.

 The Fire Department's ambulance service currently receives reimbursement for services from the different health care plans that are available from the State. Fresno County is known as a ‘two-plan' county so the majority of our fee-for-service Medi-Cal patients have a supplemental plan, either Anthem Blue Cross or Cal-Viva. The IGT program provides reimbursement of costs to patients that have these supplemental plans. The ability for the Fire Department to utilize this revenue stream for unreimbursed costs will be determined once the contracts with these supplemental plans is established. Previous to this contract the City was in contract with Ms. Elinor Hall for these same services. The prior agreement between Ms. Hall and the participating Cities was essentially the same; Ms. Hall would consult the Cities and bill the City for her services and the participating Cities would be invoiced by the City of Sanger. With this current contract the City of Sanger has now included the other participating cities as parties to the contract to eliminate any potential confusion moving forward. The Sanger Fire Department will continue to act as an intermediary between HMA and the Fire Departments of Selma, Kingsburg, Coalinga and Dinuba to keep costs down by splitting the hourly rate of HMA's services between the five departments. The Fire Department was previously in contract with Ms. Elinor Hall for the last four years. She has since retired and transferred her clients to HMA.

None of the Fire Departments in the Central Valley have the technical expertise nor institutional knowledge that is required to navigate through the various health care plans and the associated State agencies. HMA's services will be instrumental in continuing this program to further seek additional revenues into the Fire Department.

1. Do not accept the contract in which case the City will continue to seek alternative sources of increased revenues.

Per the contract, the City of Coalinga Fire Department agrees to pay HMA for their services at a rate of $295 an hour. All billable hours will be thoroughly documented and will be kept at a minimum. The Fire Chiefs from the other Cities have agreed to participate in this program and will be invoiced monthly for services from HMA. This contract is not to exceed $90,000 therefore the Fire Department's equal share would be $18,000 per year. These funds were budgeted during the budget process for FY 2020-21 within the Fire Department budget.

Additionally, it is important to note that fiscally with Ms. Hall's previous consulting services the Fire Department has received through the IGT program on average an additional $850,000 in revenues per year over the last four years.  

ACTIONS FOLLOWING APPROVAL:

Upon approval, the attached documents will be signed by the City Manager. Staff from the cities of Kingsburg, Selma, Dinuba and Sanger will present to their respective City Councils over the next two weeks and a final contract will be delivered to HMA where implementation of the program will begin immediately.