COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

DATE:

May 21, 2003

BOARD MEETING DATE:

June 10, 2003

TO:

Honorable Board of Supervisors

FROM:

Nancy Steiger, Chief Executive Officer

SUBJECT:

Amendment 2003-01 and Amendment 2003-02 to the Agreement with the

San Mateo Health Commission (HPSM)

Recommendation

Adopt a resolution authorizing the President of the Board to execute Amendment 2003-01 and 2003-02 to the 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 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. The term of the agreement was one year, from December 1, 1993 through November 30, 1994.

Collectively, your Board approved 20 more amendments after 1995. These amendments revised fee schedules, adjusted allocations, updated or replaced exhibits, and extended terms.

Discussion

Amendment 2003-1 extends the term of the agreement through December 31, 2003 and changes the allocation of pool surpluses that occurred after FY2001 when HPSM had a substantial deficit while provider accounts had significant surpluses that added to the deficit. This amendment also includes a provision that waives a 45-day delay of the effective date of this amendment.

Amendment 2003-2 changes the allocations for the physician-hospital risk pools which are contained in Exhibit 3 of San Mateo Medical Center's Medi-Cal Agreement. This amendment also includes a provision to waive the 45-day provision required by recent law change so that these allocations can be effective for the full fiscal year.

Vision Alignment

This agreement with San Mateo 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 Medical Center.

Fiscal Impact

These two amendments have no fiscal impact. These amendments do not change the amount of withhold that is returned to providers contracting with HPSM, but correct the risk sharing arrangement between the Health Plan and the providers.