AGR-7309.A - CALOPTIMA6GR'7309.A
AMENDMENT 1 TO
HEALTH PLAN-PROVIDER AGREEMENT
INTERGOVERNMENTAL TRANSFER RATE RANGE PROGRAM
AGREEMENT
This Amendment 1 is effective as of September 1, 2022, by and between CALOPTIMA, a California
public agency, hereinafter referred to as "PLAN" and the City of Orange, a California municipal
corporation operating through its Fire Department, hereinafter referred to as "PROVIDER", with respect
to the following facts:
RECITALS
A. PLAN and PROVIDER entered into a Health Plan-Provider Agreement Intergovernmental Transfer
Rate Range Program Agreement("Agreement")effective November 1, 2021 to provide for Medi-Cal
managed care capitation rate increases to PLAN as a result of intergovernmental transfers ("IGTs")
from the City of Orange (Governmental Funding Entity)to the California Department of Health Care
Services ("State DHCS") to maintain the availability of Medi-Cal health care services to Medi-Cal
beneficiaries.
B. PLAN and PROVIDER desire to amend the Agreement to reduce CalOptima's IGT retention amount.
NOW,THEREFORE,PLAN and PROVIDER hereby agree as follows:
1. Section 1.B"Health Plan Retention"shall be deleted in its entirety and replaced with the following:
B. Health Plan Retention
1) PLAN shall retain two percent (2.0%) from the Medi-Cal managed care rate
increases paid to PLAN by DHCS as described in this agreement prior to
disbursing LMMCRR IGT Payments to PROVIDER. The retained funds will
be expended by PLAN for Covered Services under PLAN's contract with
DHCS for Medi-Cal, in either the State fiscal year received, or in subsequent
State fiscal years, as appropriated by the CalOptima Board of Directors.
Each provider's share of the retained funds shall be calculated based on the
provider's proportionate share of the LMMCRR IGT payment made by PLAN in
Orange County.
2) The amounts referenced in this Amendment are estimates. The parties
understand and agree that the total amount of the Medi-Cal managed care
capitation rate increases paid by DHCS to PLAN may fluctuate as a result of
enrollment. The parties further understand and agree that any such fluctuations
will likewise affect the amount to be retained by the CalOptima and the
amount payable to PROVIDER by the same percentage as the variance in the
capitation rate increases, if any.
3) PLAN will not retain any other portion of the IGT MMCRRIs received from
the State DHCS other than those mentioned above."
2. AGREEMENT REMAINS IN FULL FORCE AND EFECT. Except as specifically amended by
this Amendment, all other conditions contained in the Agreement shall continue in full force and
effect. After the Amendment Effective Date, any reference to the Agreement shall mean the
Agreement as amended and supplemented by this Amendment. Notwithstanding anything to the
the City of Orange_IGT Funder Agreement_IGT I I_C11350520AA
contrary in the Agreement, in the event of a conflict between the terms and conditions of this
Amendment and those contained within the Agreement, the terms and conditions of this Amendment
shall prevail. Capitalized terms not otherwise defined in this Amendment shall have the meanings
ascribed to them in the Agreement. This Amendment is subject to approval by the Government
Agencies and by the CalOptima Board of Directors.
IN WITNESS WHEREOF,PLAN and PROVIDER have executed this Amendment as follows:
SIGNATURES
HEALTH PLAN: CalOptima
W ad Oct 27 2022MichaelHunn.(Oct 27,2022 08:30 PDT) Date:
By: Michael Hunn,Chief Executive Officer
PROVIDER: the C. of Orange
L 'f Date: I( ' ' ` '7
By: Mar A. urp y,Mayor
ST:
PAS Date: I O t2 I
Pamela Coleman,City Clerk
APPROVED AS TO FORM:
r
t LLA Date: (0 11 lea
Mary E. Bi ing,Asst City Attom
2
the City of Orange_MT Fonder Agreement_IGT I I_C 11350520AA