R-1841 - 11/12/2019 - IGA AGREEMENT - Resolutions Supporting Documents INTERGOVERNMENTAL AGREEMENT
BETWEEN
I HE ILLINUIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
AND
Villapg of Nk,srgak
2U20-20-
The Illinois Department of Healthcare and Family Services (the "Department" or "HFS") and
the Village of Oak Brook, (Local Government) pursuant to the Intergovernmental Cooperation Act, 5
ILCS 220/1 of seq. (the"IGA Act") and Section 2-32-030 of the Municipal Code of Chicago, hereby enter
into this Intergovernmental Agreement(the "Agreement") in connection with supplemental ambulance
rates. HFS and the Local Government are collectively referred to herein as "Parties" or individually as
a"Party.,,
ARTICLE I
INTRODUCTION
1.01 Background. Article XII of the Illinois Public Aid Code, 305 ILCS 5/5 et seq. (the "Public Aid
Code"), authorizes the Department to make use of, aid and co-operate with State and local
governmental agencies, and the IGA Act provides for cooperation between units of government. Local
Government operates a Fire Department (Provider)that is enrolled in the Medical Programs(as defined
below) and provides Covered Ambulance Services (as defined below) to individuals eligible for benefits
under the Medical Programs (as defined below); however,the costs of providing the referenced services
is not covered by the fee schedule pursuant to which the Department and its agents pay for such
services.
1.02 Purpose. In order to provide greater cost coverage to Provider for Covered Ambulance Services,
the Parties enter into this Agreement.
1.03 Definitions
(a) Agent means Managed Care Organizations and Administrative Services Organizations.
(b) ALS means Advanced Life Support billed under CPT Code A0427.
(c) BLS means Basic Life Support billed under CPT Code A0429.
(d) Base Rate means the current fee-schedule rate for Provider on the Department's rate sheet for
the Provider as of September 30,2019.
(e) Covered Ambulance Services or Services means all ALS and BLS emergency ground ambulance
services trips reimbursable under the Illinois Medicaid state plan, provided to beneficiaries of
Medical Programs, and does not include mileage or oxygen.
(f) 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 supplemental
FMAP for ACA expansion population based on the percentage of Covered Ambulance Services
provided to the different populations.
(g) Interim Rate means the payments to Provider for Covered Ambulance Services in addition to the
payments made pursuant to the state plan fee schedule and calculated pursuant to Article III.
(h) Medical Programs means programs administered by the Department under the Public Aid Code,
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 etseq.).
INTERGOVERNMENTAL.AGREEMENT
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(i) Pd111CIUa11119 Public Ambulance Provider means an ambulance provider owned by a municipal
corporation or other unit of local government that has executed an Agreement with the
Department with terms substantially identical to this Agreement.
(j) Quarterly Invoice means an Itemized statement provided to the LuLdl GOVelfllnelit by Llie
Department regarding supplemental payments for Services previously received by the Provider.
(k) Rate Year means calendar year.
(I) State Share means the portion of Medicaid claims expenditures not reimbursed using federal
matching dollars.
ARTICLE II
INTERGOVERNMENTAL TRANSFER
2.01 Local GOvernment will transfer to the Department on a quarterly basis an amount equal to 50%
of the total Interim Rates, as described in Article iII, received by Provider from the Department and its
agents for the prior quarter.
2.02 The Department will send a Quarterly Invoice to Local Government for the transfer of 50%of
the supplemental payments described in Article ill and transfer shall be made within 30 days after the
receipt and verification of the Quarterly Invoice by the Local Government.
ARTICLE III
INTERIM RATES FOR SERVICES
3.01 Calculation.The Interim Rate will be determined as follows:
I. The Department will calculate, using data from each Provider's most recent timely
filed cost report, Provider's total costs per ALS trip and BLS trip for Covered Ambulance
Services based on a submitted Department approved cost report.
ii. The Department will calculate the difference between the ALS and BLS cost per trip
calculated pursuant to(i) and the Department's published Base Rate for those trips to
establish the Provider's interim Rates for ALS and BLS.
3.02 Reimbursement.The Department shall pay or cause it agents to pay Interim Rates to Provider
for Covered Ambulance Services pursuant to this Article IiI in addition to payments made at the
Provider's Base Rate. The Interim and Base Rates will be added together during claims processing and
paid as a single rate.
3.03 Cost Reports. The Department will annually notify Provider of the cost report template to be
used and provide instructions and a due date for submission in order for Provider to be eligible for an
Interim Rate the next Rate Year.
3.04 Reconciliation. Once the Department has a cost report covering a Rate Year in which Provider
received an Interim Rate, it will calculate the actual cost per trip during the Rate Year and determine
whether the Interim Rate underpaid or overpaid Provider for the cost of the Services. If Provider was
underpaid, the Department will make a further payment to cover costs. If Provider was overpaid, the
Department will notify Provider of the net amount due to the Department,taking into account amounts
already transferred to the Department pursuant to Article II.
ARTICLE IV
TERM
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4.01 Term. This Agreement shdll cutrune ice.October t,20tq provided Provider's Cost Report was
received by the Department on or before October 1,2019,or on January 1,2020,if Provider's cost
report was received after October 1,2019 and on or before November 1,2019,and shall continue until
otherwise torminated 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 Parry.
5.03 Availability of Appropriation: Sufficiency 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(1)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 Applicablf law and Sgv_erabiti(y.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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604 Rgrord; Rgtgnt(Qn: 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 eiid of the six yeas period, the records slidll be
retained until dll issues drising Out of the dctlon are resolved.
6.05 No Personal Liability. 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:Mary.Doran@illinois.pov
Kiran.mehta@illinois.gov
To local Government: bliss@oak-brook.org
dzima.@oak-brook.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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IN WI I NESS WHEREUF, the Parties hereto have caused this Agreement to be exec ule d by Iheir duly
authorized representatives.
LOCAL GOVERNMENT
SIGNATAJR
NAME:
TITLE:
DATE C
ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
THERESA EAGLESON
DIRECTOR
DATE:
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