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HomeMy WebLinkAboutTuscarora Managed Care - Franklin CountyPage 1 of 7 ADMINISTRATIVE AGREEMENT BETWEEN THE COUNTY OF FRANKLIN AND THE TUSCARORA MANAGED CARE ALLIANCE (TMCA) THIS AGREEMENT, made this 16th day of September, 2025, by and between the County of Franklin, Pennsylvania (hereinafter referred to as Lessor ), a County of the fourth class having its principal office at the Office of the County Commissioners, 272 North Second Street, Chambersburg, Pennsylvania 17201, and the Tuscarora Managed Care Alliance (hereinafter referred to as Lessee or TMCA ), a Pennsylvania intergovernmental cooperative entity established by Franklin and Fulton Counties pursuant to 53 Pa.C.S.A. § 2301 et seq., having its principal place of business at 425 Franklin Farm Road, Chambersburg, Pennsylvania 17202. WITNESSETH WHEREAS, the Pennsylvania Medical Assistance Program (MA Program) is organized under Title XIX of the Social Security Act (42 U.S.C.A. §§ 1396 et seq.) and under the Pennsylvania Public Welfare Code, 62 P.S. § 201 et. seq., to provide payment for medical services to persons eligible for Medical Assistance (MA); and WHEREAS, Section 443.5 of the Public Welfare Code (62 P.S. § 443.5) authorizes the Commonwealth of Pennsylvania Department of Human Services (hereinafter referred to as DHS ) to provide prepaid capitation payments for services to eligible MA recipients; and WHEREAS, the United States Department of Health and Human Services Centers for Medicare and Medicaid Services (hereinafter referred to as CMS ) approved a waiver request (HealthChoices Waiver) submitted by DHS under Section 1915(b) of the Social Security Act, 42 U.S.C. 1396n to implement a mandatory managed care program under the name HealthChoices Behavioral Health (hereinafter referred to as HealthChoices ), to include MA recipients in the Pennsylvania counties of, inter alia, Franklin and Fulton (hereinafter collectively referred to as the Counties ); and WHEREAS, the Commonwealth has offered the Counties the right of first opportunity to administer the HealthChoices program in order to better coordinate behavioral health services provided under MA with other publicly funded behavioral health and human services; and WHEREAS, County has identified a public welfare need for said services; and WHEREAS, the Counties formed a multi-county intergovernmental cooperative entity known as the Tuscarora Managed Care Alliance (TMCA) for purposes of participation in HealthChoices; and WHEREAS, TMCA has agreed to be the Primary Contractor pursuant to a HealthChoices Behavioral Health Agreement between DHS and TMCA and to administer and be responsible for the execution of the HealthChoices program; and WHEREAS, TMCA must have professional expertise and support in the oversight and administration of HealthChoices; and Page 2 of 7 WHEREAS, TMCA, must oversee and manage HealthChoices in accordance with all applicable state and federal laws, rules and regulations, as they may apply; and WHEREAS, the County possesses professional expertise, facilities and support services of a nature beneficial to helping TMCA fulfill its HealthChoices required duties, operations and obligations; and WHEREAS, TMCA desires to access the expertise and support existing with the County; and WHEREAS, the Board of Commissioners of Franklin County by majority vote at a regularly scheduled meeting, approved the terms of this Agreement. NOW, THEREFORE, in consideration of the mutual promises contained herein, the parties, intending to be legally bound, hereby agree as follows: 1. Recitals: The above recitals are incorporated herein by reference thereto and made a part of this Agreement. 2. Term: The term of this Agreement shall be effective as of the 1st day of January, 2026, and shall expire on the 30th day of December, 2028. 3. Acknowledgement of Other Agreements: The parties have executed a Staffing Agreement and a Lease Agreement for office space (hereinafter collectively Agreements ). It is the intention of the parties that said Agreements are to be read cooperatively with the herein Administrative Agreement. To the extent any term of the Agreements contradict a term or terms of the herein Administrative Agreement, it is the intent of the parties that the more specific language shall govern, unless the parties mutually agree otherwise or unless mandated by DHS 4. Termination: This Agreement shall terminate One Hundred and Eighty (180) days after any of the follow: (a) TMCA s receipt of written notice of the withdrawal as a member of TMCA; or (b) In the mutual judgment of the parties, the Commonwealth of Pennsylvania materially and substantially changes the system for the provision of behavioral health services for Medicaid recipients; or (c) Written notice from one party to the other party. 5. Duties of County: County agrees to perform, to the extent not covered by separate agreement, the following: (a) To delegate to TMCA the role of HealthChoices Primary Contractor so as TMCA may Page 3 of 7 directly contract with DHS for the HealthChoices Program to serve eligible clients within the County. (b) To promptly execute all documents, writings, or other instruments necessary for the efficient and effective administration of HealthChoices by TMCA. (c) To execute all payments due and owing TMCA. (d) To appoint in accordance with the Intergovernmental Agreement, as may be amended from time to time, County staff to aid in the evaluation and monitoring of performance of the BHMCO, the Steering Committee, Quality Improvement Utilization Management Subcommittee, ad-hoc problem focused committees, Complaint and Grievance Panels, and other problem focused workgroups that may be established from time to time pursuant to the Intergovernmental Agreement. (e) Provide network, hardware and software support that meet or exceed the HIPAA Security Rule standards, telephone service support, and mail/postage services. (f) Human Resources and Payroll Functions. (g) In addition to the respective duties contained in the HIPAA Business Associate Agreement between the parties, County, as TMC s primary information technology provider, shall supply TMCA, to extent relevant to TMCA s protected information including storage, transmission and access thereto, (i) the results of any County HIPAA audit; (ii) the results of any County HIPAA risk analysis; and (iii) information necessary to complete TMCA's HIPAA risk analysis and any other subsequent related HIPAA activities. 6. Duties of TMCA: TMCA agrees to perform the following administrative duties: (a) To provide professional personnel, either through direct employment or subcontract, for general administration and oversight of HealthChoices. (b) Planning, organizing, conducting and directing the operations of HealthChoices. (c) Evaluating and monitoring the performance of the BH-MCOs. (d) Overseeing the resolution of complaints, grievances and appeals brought by consumers, family members, providers and/or other interested parties. (e) Providing consultation and technical assistance to County on matters related to managed behavioral health care. (f) Facilitate and manage a management information system (MIS) through a contractual relationship with Allan Collautt Associates or other technology provider as may be selected from time to time. Page 4 of 7 (g) Perform any other duties as may be assigned by DHS or as otherwise necessary for achieving the objectives of HealthChoices. (h) To comply with all requirements and provisions of the DHS/TMCA HealthChoices Contract; (i) TMCA shall complete all required forms and submit them to OMHSAS within the required time frame. (j) TMCA agrees to insure that all records and other materials related to clients receiving services shall be kept confidential. (k) To make all required Pennsylvania Managed Care Organization Assessment reports, returns and remittances. (l) Fully comply with all federal and state laws regarding information confidentiality. 7. Insurance: The parties agree to be responsible for the following insurance: (a) County (i) Commercial General liability and Commercial Property insurance covering liabilities for death and personal injury and liabilities for loss of or damage to property with a combined single limit of not less than One Million Dollars ($1,000,000.00) per occurrence and Two Million Dollars ($2,000,000.00) in the aggregate. (ii) Workers ation as required by the laws of the Commonwealth of Pennsylvania. (b) TMCA (i) Business Owners Property and Liability insurance with a combined single limit of not less than One Million Dollars ($1,000,000.00) per occurrence and Two Million Dollars ($2,000,000.00) in the aggregate, naming the County of Franklin as an additional insured. (ii) Directors and Officers liability insurance with a combined single limit of not less than One Million Dollars ($1,000,000.00) per occurrence and Two Million Dollars ($2,000,000.00) in the aggregate. (iii)Errors and Omissions insurance with a combined single limit of not less than One Million Dollars ($1,000,000.00) per occurrence and One Million Dollars ($1,000,000.00) in the aggregate. (iv) Cyber Insurance with a limit of not less than One Million Dollars ($1,000,000.00) per occurrence and a Two Million Dollar ($2,000,000.00) aggregate limit Page 5 of 7 8. Conditions Precedent: The parties specifically condition all obligations and payments to each other under this Agreement upon the fulfillment by any relevant state or federal funding source of their obligations and payment responsibilities to each other for the services to be provided hereunder. 9. General Standards / Statutory and Regulatory Compliance: TMCA shall perform and comply at all times relative hereto with all applicable state and federal laws and regulations and all DHS program requirements in its business and activities which pertain to the performance or funding of this Agreement. 10. Medical Assistance Exclusion Screening: Pursuant to, inter alia, the Commonwealth of Pennsylvania Department of Human Services Medical Assistance Bulletin 99-11-05 as amended or supplemented, if County is enrolled in the Medical Assistance Fee-For-Service FF ) program or if any part of County s funding under this Agreement originated, either directly or indirectly, from participation in Medicare, Medicaid, the State Childre Health Insurance Program (SCHIP ), or any other Federal health care program as defined in the Social Security Act, (42 U.S.C.A. § 1128B(f)), then County shall develop policies and procedures, and shall supply TMCA with true and correct copies of said policies and procedures upon request, for screening of all employees and contractors (both individuals and entities), at time of hire or contracting; and, thereafter, on an ongoing monthly basis to determine if they have been excluded from participation in federal health care programs by searching (1) the United States Department of Health and Human Services (H ffice of Inspector General (OIG ) List of Excluded Individuals/Entities (LEIE ); (2) the United States General Services Administration (GSA ) Excluded Parties List System (EPLS ); and (3) the Commonwealth of Pennsylvania Department of Human Services Medicheck List databases. If any individual or entity so screened shall appear in any of the aforementioned databases then County shall immediately self-report any discovered exclusion to the Commonwealth of Pennsylvania Bureau of Program Integrity and to TMCA. County shall develop and maintain auditable documentation, and shall supply TMCA with true and correct copies of said documentation upon request, of screening efforts, including dates the screenings were performed and the source data checked and its date of most recent update, and periodically conduct self-audits to determine compliance with this requirement. 11. Quality Assurance: As required, TMCA shall provide all necessary documentation to ensure compliance with federal regulations associated with DHS endent external quality review organization. TMCA further agrees to fully cooperate with County in performing its required due diligence to assess TMCA s compliance with and ability to perform its obligations under this Agreement. In connection therewith, TMCA shall throughout the term of this Agreement maintain an internal quality assurance (QA ) program that, at a minimum, identifies deficiencies or areas for improvement in the performance of its obligations and reports such findings, along with appropriate corrective action plans, to Franklin County on a regular basis. 12. HealthChoices Mandated Audit: TMCA shall contract with a certified public accounting firm to perform the HealthChoices mandated financial report audit and a financial statement audit. TMCA shall pay the accounting firm for all duties performed per the terms of the contract. Page 6 of 7 13. Reimbursement: TMCA shall reimburse County for the time that County employees expend for the evaluation and monitoring of performance of the BHMCO, as more fully described in section 5 of this Agreement, and for other HealthChoices County specific obligations not otherwise delegated to TMCA. County shall document, in the form specified by TMCA, the time spent by any County employee for such purposes. The County shall submit a detailed invoice, and any supporting documentation when requested, to TMCA on a monthly basis, for reimbursement for the prior month. The County shall have a monthly administrative allowance of up to 19% of the total monthly invoice. The amount billed to TMCA may not exceed a total of $129,427.00 for calendar year 2026, $133,292.00 for calendar year 2027, and $137,273.00 for calendar year 2028, for the expenses herein described that are not set forth in the Staffing Agreement. TMCA reserves the right to review the submitted claim documents for accuracy and deny payment of any submission that cannot be verified by TMCA due to lack of documentation provided by the County. TMCA agrees to provide written notice to the County if it requires additional information and allow reasonable time and opportunity to provide additional documentation and/or information. 14. Standard of Conduct: TMCA agrees that all employees of TMCA will behave and conduct themselves reasonably, prudently, and courteously in such a manner as not to reflect adversely upon the County; and will perform at all times faithfully, industriously, and to the best of their ability, experience, and talents, all of the duties that may be required of them pursuant to the expressed terms of this Agreement. 15. Severability: All agreements, provisions and covenants contained in this Agreement are severable, and in the event any of them are held to be invalid by any competent court, this Agreement will be interpreted as if the invalid agreements, provisions or covenants were not contained in this Agreement. In the event Provider does not comply with a term, provision or condition of the Agreement, the County may, at its discretion, deem such noncompliance as grounds for severing the term, provision or condition without affecting the remainder of this Agreement or parts thereof. 16. Integration: This Agreement constitutes the entire understanding of the parties with respect to the subject matter of this Agreement and cancels, supersedes and terminates all prior agreements, contracts, understandings, negotiations, and other arrangements between the parties whether written or oral or partly written and partly oral. 17. Amendment/Waiver: Any alterations, variations, modifications, amendments, waivers or additional provisions to this Agreement will be valid only when reduced to writing, duly signed by all parties, and attached hereto. No oral amendment or waiver shall be effective and this provision may not be orally amended or waived. The parties hereto further agree that any particular course of performance may Page 7 of 7 not be used by any trier-of-fact to imply or infer a modification of this Agreement. 18. Governing Law: This Agreement shall be construed and governed pursuant to the laws of the Commonwealth of Pennsylvania pursuant to the execution of this Agreement in said jurisdiction. Any choice of laws issues shall be deemed to utilize the choice of laws rules of the Commonwealth of Pennsylvania. Any dispute arising from this Agreement shall be heard in the Court of Common Pleas for the Thirty-Ninth Judicial District of Pennsylvania-Franklin County Branch. 19. Counterparts: This Agreement may be executed in multiple counterparts. IN WITNESS THEREOF, the parties hereto have executed this Agreement as of the day and year first above written. ATTEST: COUNTY of FRANKLIN COMMONWEALTH of PENNSYLVANIA ____________________________ ______________________________ Carrie Gray, Dean Horst, Chairman Chief Clerk/County Administrator Board of Commissioners ______________________________ John Flannery {SEAL}Board of Commissioners ______________________________ Robert Ziobrowski Board of Commissioners ATTEST: TMCA ______________________________ _______________________________ Melissa L. Wileman, Executive Director _______________________________ Robert Ziobrowski, Treasurer