HomeMy WebLinkAbout117-R-19 Authorizing the City Manager to Execute an Intergovernmental Agreement with the Illinois Department of Healthcare and Family Services10/17/2019
117-R-19
A RESOLUTION
Authorizing the City Manager to Execute an Intergovernmental
Agreement with the Illinois Department of Healthcare
and Family Services
WHEREAS, the City of Evanston ("Evanston") and the Illinois Department
of Healthcare and Family Services ("DHFS") are desirous of providing greater cost
coverage to the Evanston Fire Department ("EFD") for the provision of ambulance
services reimbursable under the Illinois Medicaid state plan and beneficiaries of medical
programs administered by DHFS; and
WHEREAS, Article VII, Section 10 of the 1970 Illinois Constitution and the
Illinois Intergovernmental Cooperation Act, 5 ILCS 220/1, et seq., authorize and
encourage intergovernmental cooperation; and
WHEREAS, the Parties desire to enter into the attached
intergovernmental agreement to set forth the rights and obligations of Evanston and
DHFS with respect to the receipt and distribution of enhanced rates for services
reimbursable under the Illinois Medicaid state plan and beneficiaries of medical
programs administered by DHFS; and
WHEREAS, the Evanston City Council have determined that it will serve
and be in the best interest of the City to enter into the Agreement with DHFS;
NOW BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
EVANSTON, COOK COUNTY, ILLINOIS:
SECTION 1: Recitals. The City Council hereby adopts the foregoing
recitals as its findings, as if fully set forth herein.
SECTION 2: The City Council hereby approves, pursuant to the City of
Evanston's home rule power, the Agreement in the form attached to this Resolution as
Exhibit A.
SECTION 3: The City Manager is hereby authorized to sign the
"Intergovernmental Agreement Between the Department of Healthcare and Family
Services and the City of Evanston", attached hereto as Exhibit A and incorporated
herein by reference.
SECTION 4: This Resolution shall be in full force and effect from and after
its passage and approval in the manner provided by law.
Attest:
Dev&r; R�i�l, G*Tq C1
d�atd� Garet, 1UCW'1 C►ky cXerl<
Adopted: OCAOb f o,R , 2019
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Stephen H./Hagerfy,M-'P'y0r
Approved as to (form:
Xl� OS - 7U-��
Michelle L. Masoncup, Corp6ration
Counsel
EXHIBIT A
INTERGOVERNMENTAL AGREEMENT
INTERGOVERNMENTAL AGREEMENT
BETWEEN
THE DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
AND
CITY OF EVANSTON
2020-2021
The Illinois Department of Healthcare and Family Services (HFS or the Department) and the City of
Evanston, pursuant to the Intergovernmental Cooperation Act, 5 ILCS 220/1 et seq., hereby enter into
this Intergovernmental Agreement (Agreement) in connection with enhance rates for ambulance
services. HFS and the City of Evanston are collectively referred to herein as "Parties" or individually as a
"Part "
Y•
ARTICLE I
INTRODUCTION
1.01 Background. Article XII of the Illinois Public Aid Code authorizes the Illinois Department of
Healthcare and Family Services to make use of, aid and co-operate with State and local governmental
agencies and the Intergovernmental Cooperation Act, 5 ILCS 220/1 et seq. provides for cooperation
between units of government. Provider operates a Fire Department (Provider) that is enrolled in the
Medical Assistance Program that provides covered ambulance services to individuals eligible for benefits
under the Medical Programs; the costs of providing the services described above is not covered by the
fee schedule pursuant to which the Department and Managed Care Organizations (MCOs) pay for such
services.
1.02 Purpose. In order to provide greater cost coverage to Provider through enhanced rates for
services, the Parties enter into this Intergovernmental Agreement.
1.03 Definitions
(a) Covered Ambulance Services means all ambulance services reimbursable under the Illinois
Medicaid state plan and provided to beneficiaries of Medical Programs.
(b) Effective Federal Match Rate means the weighted average of the Federal Medical Assistance
Percentage (FMAP) for Illinois non -Affordable Care Act (ACA) enrollees and the enhanced FMAP
for ACA expansion population based on the percentage of specified covered services to the
different populations.
(c) Fee -for -service or FFS means the services under Medical Programs reimbursed to providers
directly by the Department and not through an MCO.
(d) Managed Care Program means services under the Medical Programs for which the Department
pays a capitated payment to MCOs to cover the cost of covered medical services.
(e) Managed Care Organization (MCO) means an entity under contract with the Department
receiving capitated payments and at risk for providing reimbursement for enrollees.
(f) Medical Programs means programs administered by the Department under the Illinois Public Aid
Code (305 ILCS 5/5 et seq.), the Children's Health Insurance Program Act (215 ILCS 106/1 et seq.)
and the Covering All Kids Health Insurance Act (215 ILCS 170/1 et seq.)_
INTERGOVERNMENTAL AGREEMENT
Page 2 of 5
(g) Participating Municipal Ambulance Provider means an ambulance provider owned by a
municipal corporation that has executed an Intergovernmental Agreement with the Department
with terms substantially identical to this Agreement.
(h) Specified Covered Ambulance Services means emergency and non -emergency Basic Life Support
and Advanced Life Support trips and does not include mileage or oxygen.
ARTICLE II
INTERGOVERNMENTAL TRANSFER
2.01 Provider will transfer on a periodic basis to the Department an amount equal to 50% of the total
enhanced rates paid to Provider by the Department and all MCOs for the period.
2.02 For FFS payments, the Department will send a monthly invoice to Provider for the higher FFS
payments described in Article III.
2.03 For MCO payments, the transfer of 50% of the supplemental payment described in Article III
shall be made within 14 days after the receipt of enhanced payments from the MCO.
ARTICLE III
ENHANCED RATES FOR SERVICES
3.01 Expenditures. The Department shall pay or cause MCOs to pay enhanced rates to Provider for
specified covered ambulance services pursuant to this Article III in addition to payments made at the
Department's published fee schedule.
3.02 The enhanced rate will be determined as follows:
a. The Department will establish classes of similar Participating Municipal Ambulance
Providers.
b. For each provider in the class, the Department will calculate an amount as follows using
data from each provider's most recent cost report:
i. Provider's total costs for covered ambulance services will be calculated based on
submittal of the Department's approved cost report.
ii. Total fee schedule payments received for covered ambulance services by Provider will
be subtracted from costs to determine the cost coverage gap.
iii. The cost coverage gap will be divided by the number of Specified Covered Ambulance
Services to determine a per service add -on payment
3.03 For FFS claims, the Department will add the calculated add -on amount to Provider's rate on the
FFS fee schedule and the enhanced rate will be paid with the original claim.
3.04 On a quarterly basis, using encounter data of paid claims from each MCO in the Managed Care
Program received by the Department during the quarter, the Department will identify the number of
Specified Covered Ambulance Services provided to each MCO's enrollees by Provider multiplied by the
uniform add -on fee and cause each MCO to pay provider the amount so calculated.
3.05 If mutually agreed upon by the Department and all Participating Municipal Ambulance
Providers, the payment of enhanced rates may be moved from a quarterly basis to a monthly basis.
K
INTERGOVERNMENTAL AGREEMENT
Page 3 of 5
ARTICLE IV
TERM
4.01 Term. This Agreement shall commence October 1, 2019, or as soon as federal approval is
received for the Directed Payments required by this Agreement and shall continue until otherwise
terminated by the Parties.
ARTICLE V
TERMINATION
5.01 Termination on Notice. This Agreement may be terminated by either Party for any or no reason
upon thirty (30) days' prior written notice to the other Party.
5.02 Termination for Cause. In the event either Party breaches this Agreement and fails to cure such
breach within ten (10) days' written notice thereof from the non -breaching Party, the non -breaching
Party may terminate this Agreement upon written notice to the breaching Party.
5.03 Availability of Aoorooriation: Sufficiencv of Funds. This Agreement is contingent upon and
subject to the availability of sufficient funds. The Department may terminate or suspend this
Agreement, in whole or in part, without advance notice and without penalty or further payment being
required, if (i) sufficient funds for this Agreement have not been appropriated or otherwise made
available to the Department by the State or the Federal funding source, (ii) the Governor or the
Department reserves funds, or (iii) the Governor or the Department determines that funds will not or
may not be available for payment. The Department shall provide notice, in writing, to Provider of any
such funding failure and its election to terminate or suspend this Agreement as soon as practicable. Any
suspension or termination pursuant to this Section will be effective upon the date of the written notice
unless otherwise indicated.
ARTICLE VI
MISCELLANEOUS
6.01 Renewal. This Agreement may be renewed for additional periods by mutual consent of the
Parties, expressed in writing and signed by the Parties.
6.02 Amendments. This Agreement may be modified or amended at any time during its term by
mutual consent of the Parties, expressed in writing and signed by the Parties.
6.03 Applicable Law and Severabilitv. This Agreement shall be governed in all respects by the laws of
the State of Illinois. If any provision of this Agreement shall be held or deemed to be or shall in fact be
inoperative or unenforceable as applied in any particular case in any jurisdiction or jurisdictions or in all
cases because it conflicts with any other provision or provisions hereof or any constitution, statute,
ordinance, rule of law or public policy, or for any reason, such circumstance shall not have the effect of
rendering any other provision or provisions contained herein invalid, inoperative or unenforceable to
any extent whatsoever. The invalidity of any one or more phrases, sentences, clauses, or sections
contained in this Agreement shall not affect the remaining portions of this Agreement or any part
thereof. In the event that this Agreement is determined to be invalid by a court of competent
jurisdiction, it shall be terminated immediately.
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INTERGOVERNMENTAL AGREEMENT
Page 4 of 5
6.04 Records Retention. The Parties shall maintain for a minimum of six (6) years from the later of
the date of final payment under this Agreement, or the expiration of this Agreement, adequate books,
records and supporting documents to comply with the Illinois State Records Act. If an audit, litigation or
other action involving the records is begun before the end of the six -year period, the records shall be
retained until all issues arising out of the action are resolved.
6.05 No Personal Liabilitv. No member, official, director, employee or agent of either Party shall be
individually or personally liable in connection with this Agreement.
6.06 Assignment: Binding Effect. This Agreement, or any portion thereof, shall not be assigned by any
of the Parties without the prior written consent of the other Parties. This Agreement shall inure to the
benefit of and shall be binding upon the Parties and their respective successors and permitted assigns.
6.07 Precedence. In the event there is a conflict between this Agreement and any of the exhibits
hereto, this Agreement shall control. In the event there is a conflict between this Agreement and
relevant statute(s) or Administrative Rule(s), the relevant statute(s) or rule(s) shall control.
6.08 Entire Agreement. This Agreement constitutes the entire agreement between the Parties; no
promises, terms, or conditions not recited, incorporated or referenced herein, including prior
agreements or oral discussions, shall be binding upon either Party.
6.09 Notices. All written notices, requests and communications may be made by electronic mail to
the e-mail addresses set forth below.
To HFS: Marv.Doran@illinois.pov
Kiran.Mehta@illinois.gov
To the Citv of Evanston: Brian Scott, Fire Chief
bscott citvofevanston.orR
Paul Polep, Fire Deputy Chief
ppolep@citvofevanston.org
6.10 Headings. Section and other headings contained in this Agreement are for reference purposes
only and are not intended to describe, interpret, define or limit the scope, extent or intent of this
Agreement or any provision hereof.
6.11 Counterparts. This Agreement may be executed in one or more counterparts, each of which
shall be considered to be one and the same agreement, binding on all Parties hereto, notwithstanding
that all Parties are not signatories to the same counterpart. Duplicated signatures, signatures
transmitted via facsimile, or signatures contained in a Portable Document Format (PDF) document shall
be deemed original for all purposes.
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INTERGOVERNMENTAL AGREEMENT
Page 5 of 5
IN WITNESS WHEREOF, the Parties hereto have caused this Agreement to be executed by their duly
authorized representatives.
CITY OF EVANSTON
Erika Storlie
Interim City Manager
Date:
ILLINIOIS DEPARTMENT OF HEALTHCARE AND
FAMILY SERVICES
Theresa Eagleson
Director
Date:
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