COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Department of Hospital and Clinics

DATE:

July 2, 2002

BOARD MEETING DATE:

July 23, 2002

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer

SUBJECT:

Agreement with the San Mateo Health Commission

Recommendation

Adopt a resolution authorizing the President of the Board to execute a Professional Services agreement with the San Mateo Health Commission.

Background

On January 11, 1994, your Board approved an agreement with the San Mateo Health Commission for San Mateo County General Hospital (SMCGH) to serve as a participating hospital in the Health Plan of San Mateo (HPSM), the Medi-Cal capitated program. All San Mateo County Medi-Cal patients are automatically enrolled in the HPSM and are assigned to hospital affiliated primary care providers.

Discussion

As part of the Health Plans negotiations with the State, certain aid codes were dropped from Health Plan coverage. This included emergency and prenatal care for undocumented immigrants. The elimination of coverage by the HPSM for certain undocumented individuals (known as OBRA-linked clients who only qualify for Medi-Cal because they are receiving emergency services or are pregnant), effective February 1, 2002, will have a substantial financial impact on SMCGH. While reimbursement for these services will now be available directly from the State, more service denials are anticipated since the State's eligibility guidelines for OBRA inpatient services are much stricter than the Health Plan's have been. The best estimate at this time is that these denials will cause a $1.4 million annual decrease in Medi-Cal reimbursement for the Health Center.

Vision Alignment

This agreement with San Mateo County Health Commission keeps the commitment of Ensuring Basic Health and Safety for All and goal number 5: Residents have access to healthcare and preventive care. The agreement contributes to this commitment and goal by providing a mechanism to pay for Medi-Cal reimbursable hospital and medical services provided to San Mateo County Medi-Cal recipients at San Mateo County General Hospital.

Fiscal Impact

The Health Plan agrees to pay the County $1,000,000 in four equal installments by June 1, August 1, October 1, and December 1, 2002. The County will provide status reports by May 31, July 31, September 30 and a final report by December 30, 2002. Due to the uncertainties of the Health Plan, these monies were not included in the proposed 2002-03 budget and will be included in a September change to recognize the funds.