COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Department of Hospital and Clinics

DATE:

May 16, 2002

BOARD MEETING DATE:

June 4, 2002

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer

SUBJECT:

Resolution Authorizing the Controller to Pay Non-Contract Medical Service Providers

Recommendation

Adopt a resolution authorizing the Controller to pay non-contract medical service providers for services to medically indigent adult (MIA) patients.

Background

San Mateo County is responsible for providing necessary medical care to its medically indigent (MIA) population. If an MIA patient needs services or procedures not offered at SMCGH, the patient is referred to another facility and the expenses must be paid by the County. Examples of these services are invasive/non-invasive cardiac procedures and radiation therapy.

Since 1990, your Board has authorized the Controller to pay non-contract medical providers who provide medical services at other facilities to our MIA patients. The authorization expires annually.

Discussion

All referrals to non-contract providers must be authorized by Hospital Administration, and utilization review is concurrently provided by the Case Management Department at the hospital.

Due to the unpredictability of expensive diagnostic procedures that patients require and the increase in clinic utilization over the past three years, demand for these services has averaged approximately $250,000.

This resolution will allow the Controller to pay non-contract providers for services provided at the prevailing Medicare participating fee schedule for all Part "B" services that can be reimbursed per Health Care Financing Administration (HCFA) guidelines or the Medicare Labor Adjusted Ambulatory Surgery Classification (ASC); and 40% of billed charges for all services not found on the Part "B" Medicare Fee Schedule or the ASC.

Vision Alignment

This agreement keeps the commitment to Ensure Basic Health and Safety for All and goal number 5: Provide residents access to healthcare and preventive care. The agreement contributes to this commitment and goal by continuing to provide healthcare services to county patients.

Fiscal Impact

The average annual cost of services paid for under this new resolution will be approximately $250,000. The resolution allows the Controller to pay bills for services provided March 1, 2002 to February 28, 2003.

Funds for these services have been budgeted in the 2001-02 San Mateo County General Hospital approved budget and will be included in the 2002-03 recommended budget.